The jigsaw sign. A reliable indicator of congenital aetiology in os odontoideum

European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
Andrew B FaganJohn W S Earwaker

Abstract

There is evidence in the literature for both a congenital and a post-traumatic aetiology for os odontoideum. In no series published to date has CT been used to aid in the diagnosis. This is a prospective study of the history of trauma and presence of diagnostic features on CT of 18 consecutive cases with os odontoideum. Our objective was to derive clinically useful radiological features enabling accurate differentiation between congenital and post-traumatic aetiologies. A mid-sagittal CT reconstruction of the atlanto-dens joint was obtained. Hypertrophy of the anterior arch of the atlas was quantified by measurement of the arch-peg-area ratio. The presence of dysplastic features (a positive "jigsaw" sign) of the atlanto-axial joint were noted. These included narrowing of the cartilage space and interdigitation of the two joint surfaces. A history of a potential traumatic aetiology was only obtained in one of the 18 (6%) in our series. A significant elevation of the arch-peg ratio was found when comparing this series to 85 controls. And a positive jigsaw sign was observed in 75% of cases. These features were not seen in paediatric cases of atlanto-axial instability, including odontoid non-union. In conclusion, an elevated arch-p...Continue Reading

References

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Citations

May 3, 2005·Pediatric Radiology·Rachel L ChoitChristopher W Reilly
Dec 3, 2011·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Shenglin Wang, Chao Wang
Jan 29, 2005·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Michel Benoist
Jul 5, 2011·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Xian-zhong Meng, Jia-xin Xu
Feb 3, 2011·Journal of Neurosurgery. Pediatrics·Corinna C ZygourakisMark R Proctor
Oct 9, 2012·Journal of Neurosurgery. Spine·Brian J McHughMichael L DiLuna
May 13, 2014·Surgical Neurology International·David StrausVincent C Traynelis
Jan 8, 2008·Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia·J E Brecknell, G M Malham
Sep 27, 2012·Clinical Neurology and Neurosurgery·Pravin SalunkeKanchan K Mukherjee
Jan 31, 2016·Child's Nervous System : ChNS : Official Journal of the International Society for Pediatric Neurosurgery·Jonas Walbom, Anders Kruse
Dec 1, 2015·International Journal of Paleopathology·A R Titelbaum, S Uceda Castillo

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