Non-surgical treatment options for os odontoideum mainly involve conservative management strategies such as clinical and radiographic surveillance, along with immobilization devices like cervical collars or halo vests for symptomatic stabilization.
Asymptomatic patients with stable os odontoideum may be managed conservatively with close monitoring, including regular clinical assessments and imaging to detect any progression of instability or neurological symptoms NICE CKS. Immobilization with a cervical collar or halo vest can be used temporarily to minimize neck movement and theoretically reduce instability or risk of spinal cord injury NICE CKS Guil Sànchez 2013.
However, conservative treatment is typically considered on a case-by-case basis depending on factors such as patient age, activity level, presence of comorbidities, syndromic associations, and radiographic findings suggesting stability. The risk of severe neurological deterioration or sudden death from trivial trauma must be carefully balanced against the risks of surgery in each patient Sakhrekar et al. 2024.
Notably, surgical fixation is generally recommended for patients with symptomatic instability or neurological deficits, but for stable, asymptomatic cases, conservative management including activity modification and avoidance of risky situations may be sufficient Sakhrekar et al. 2024 Muthu et al. 2025. Protection against traumatic injury by using immobilization devices can temporarily help manage symptoms and provide mechanical support, though the evidence base for long-term non-surgical stability is limited NICE CKS Guil Sànchez 2013.
Current UK guidelines on odontoid fractures extrapolated to os odontoideum highlight no operative treatment standard is established for asymptomatic patients, recommending surveillance and conservative care unless neurological signs or instability develop NICE CKS. Literature reviews reinforce that conservative care may be chosen in selected stable patients but underscore the high risk of neurological worsening from minor trauma if untreated, leading many experts to favour surgical intervention for symptomatic or unstable cases Sakhrekar et al. 2024 Chang et al. 2019.
Key References
- CKS - Radiculopathy (cervical) - neck pain
- CKS - Cervical radiculopathy - neck pain
- NG38 - Fractures (non-complex): assessment and management
- (Guil Sànchez and Rodríguez-Martín, 2013): [Odontoid fractures with a poor final outcome in an elderly patient: presentation of a case and a review of the current literature].
- (Joaquim et al., 2025): A Correlation Among the Most Classic Axis Injuries Classification and the New AO Upper Cervical Spine Classification System.
- (Sakhrekar et al., 2024): Philosophies And Surgical Techniques on Os Odontoideum Treatment with Literature Review.
- (Muthu et al., 2025): Os odontoideum-induced sudden onset myelopathy following cervical extension injury in an adult-case report on challenges and management with 3D navigation technology.
- (Chang et al., 2019): Posterior Sublaminar Wiring and/or Transarticular Screw Fixation for Reducible Atlantoaxial Instability Secondary to Symptomatic Os Odontoideum: A Neglected Technique?