Radiologic evaluation is utilized to confirm the diagnosis and estimate the degree of spinal instability. Initial evaluation includes open-mouth, anterior-posterior, and flexion-extension lateral radiographs. Os odontoideum appears as a round or oval ossicle with a smooth, uniform cortex separated from the base of the axis by a wide gap. The ossicle border does not directly match up with the axis body. The gap separating the os and the axis proper should lie above the level of the superior articular facets. Orthotopic os odontoideum (see image below) may appear free and in a relatively anatomic position.
30,31,32
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