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Abstract Os odontoideum is an uncommon abnormality of the second cervical vertebra, the aetiology of which is contentious. Whether congenital or acquired, the condition often results in atlantoaxial instability and subsequent compression of cervical cord or vertebrobasilar vessels. The bioarchaeological study of a medieval sample from the Christian necropolis of Cacela Velha (Algarve, southern Portugal) provided the opportunity to describe one of the first cases of this rare anomaly ever reported in the palaeopathological record. Copyright © 2007 John Wiley & Sons, Ltd.
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