By definition, an os odontoideum is a small accessory ossicle with smooth, well-corticated borders that is separated from the base of a shortened odontoid process. The size and shape of the ossicle can vary. The atlanto-axial joint exhibits the greatest mobility in the vertebral column and is also the least stable. Os odon-toideum frequently leads to atlanto-axial instability with spinal-cord compression. Atlanto-axial instability can arise from multiple causes including inflammatory arthritides, trauma, infection, laxity of the transverse ligament, e.g. trisomy 21 and other congenital abnor-malities. Plain cervical spinal radiographs are usually sufficient to obtain a diagnosis.
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