Background: Symptomatic retro-odontoid pseudotumor (ROP) causing cervical myelopathy is generally treated surgically because of the risk of neurological deterioration. However, here, we present an 82-year-old female in whom stabilization for 6 months in a soft cervical collar results in mass and symptom regression. Case Description: An 82-year-old female developed a right hemiparesis. Her deficit was attributed to a cervical magnetic resonance imaging (MRI) that demonstrated a T2-hypointense retro-odontoid mass compressing the spinal cord, causing intramedullary T2 hyperintensity. Posterior surgical stabilization/decompression was recommended, but she declined surgery. She was treated with a soft cervical collar and gradually improved. Over 6 months, the right incomplete hemiparesis resolved. The follow-up MRI demonstrated spontaneous regression of the retro-odontoid mass, resolution of cord compression, and no residual hyperintense T2 cord signal. She remains stable and asymptomatic 2 years later. Conclusion: Although surgery remains the standard for symptomatic ROP, strict cervical immobilization – even with a soft collar – may be a reasonable option in selected (i.e., particularly elderly) patients.
Kawanishi et al. (2026) studied this question.