Why Most Patients Don't Need Surgery for a Retroflexed Dens

Dr. Centeno discusses retroflexed dens and why that usually isn't by itself causing CCI or craniocervical instability symptoms. He goes into depth into the published research that supports that retroflexed dens is common in patients with no problems. He also discusses how a retroflexed dens plus instability acts as an accelerant for symptoms. Hence, patients with retroflexed dens and CCI need to get the instability fixed, but most do not need to get the retroflexed dens removed or decompressed.

[@Mr.Nick1324]

Great video! The point that a patient like this often won’t have symptoms until one day they do made a ton of sense to me. This has been exactly our experience, and that’s with both Chiari and retroflex dens. Thanks for doing these.

[@centenohome]

Thanks!

[@markf1910]

Around the 4 minute mark it sounded like the more lordosis your neck has the more retroflexed your odontoid can become. From your recommendation to sit up and try to improve posture/curve wouldn’t this increase the retroflexion which may increase symptoms? It sounds like they counteract each other and not sure which is better/worse. Are there cases where you don’t want to improve curve as it may lead to increased retroflexion?

[@centenohome]

It's a bit more complex. The worst for a retroflexed odontoid patient is a forward head kyphotic posture (common). That causes hyperlodosis in the cervical spine and increased compression from the retroflexed dens. The best is a normal posture. In rare patients, a straighter cervical curve could be better. This is all specific to patients with a retroflexed odontoid.