Congenital Missing Cervical Pedicle

Yıl 2016, Cilt: 2 Sayı: 2, 122 - 125, 01.04.2016

Ruan Vasandani Jawad Shah Sirajeddin Belkhair

https://doi.org/10.5455/umj.20160807014910

Öz

Background: A congenitally missing cervical pedicle should be part of the differential diagnosis when evaluating a patient with a traumatic injury to the cervical spine to prevent unnecessary surgical intervention. Patients having this congenital abnormality usually present after traumatic incidents and therefore are commonly misdiagnosed as a cervical fracture or dislocation. Radiographic imaging showing a missing cervical pedicle should be further investigated in order to avoid misdiagnosis and needless treatment. This report is published to increase awareness among physicians about congenitally missing cervical pedicle. Case presentation: A 17 year old obese female patient presented to the ER with neck pain after a motor vehicle crash. Neurological and physical exam were unremarkable except for neck stiffness. Computed tomography scan of the cervical spine revealed a missing left sided C6 pedicle. The patient was initially diagnosed with a C5-C6 subluxation and prescribed a halo vest until further evaluation and additional imaging. CT scan confirmed a left side C6 congenital missing pedicle, halo was removed and patient was treated by conservative measures. Conclusion: In reviewing more than 70 articles from literature, congenital missing cervical pedicles are identified as a rare finding and often misdiagnosed especially when presenting after traumatic accidents. Careful review of literature proves that conservative measures are treatment of choice. Also restrictions regarding physical activity imposed after diagnosis is more precautionary rather than absolute.

Anahtar Kelimeler

Missing pedicle, congenital missing pedicle, missing cervical pedicle

Kaynakça

• Moon, Sung-Jun, Jung-Kil Lee, Bo-Ra Seo, and Soo-Han Kim. Traumatic Subluxation Associated With Absent Cervical Pedicle. Spine 3.18 (2008): 663-66.
• Kitzing, Bjoern, and Yu Xuan Kitzing. The Role of CT Imaging in the Congenital Absence of a Cervical Spine Pedicle: A Case Report and Review of the Literature. Neuroradiology 3.5 (2009): 7-10.
• Oh, Young-Min, Jong-Pil Ei. Congenital Absence of a Cervical Spine Pedicle: Report of Two Cases and Review of the Literature. The Korean Neurosurgical Society 44 (2008): 389-91.
• Fowler, John R. Absent C6 Cervical Pedicle in a Collegiate Football Player. Clinical Orthopaedics and Related Research (2010): 1693-696.
• Jonas Sheehan, George Kaptain, John Jane. Congenital Absence of a Cervical Pedicle: Report of Two Cases and Review of the Literature. Neurosurgery 47.6 (2000): 1439-442.
• Mays, Simon. Absent Cervical Spine Pedicle: Report of a Case in a Mediaeval Skeleton. Skeletal Radiol 36 (2007): 773-77.
• Taguchi, Yoshio, Motoshi Matsuzawa, Jun Ming Ye, Masahiko Uzura, Hiroyuki Watanabe, Minako Hayakawa. Posttraumatic Cervical Epidural Hematoma Associated with Congenital Absence of a Cervical Spine Pedicle: Case Report and Lierature Review. The Journal of Trauma 51 (2001): 579-82.
• Parizel, P. M., T. Van Der Zijden, S. Gaudino, M. Spaepen, M. H.J. Voormolen, C. Venstermans, F. De Belder, L. Van Den Hauwe, and J. Van Goethem. Trauma of the Spine and Spinal Cord: Imaging Strategies. European Spine Journal 6 (2009): 8-17.
• Wiener, David, Salutario Martinez, David A. Congenital Absence of a Cervical Spine Pedicle: Clinical and Radiologic Findings. American Journal of Roentgenology 155 (1990): 1037-041.
• Rodriguez, Romero R. Congenital Absence of the Neural Arch in the Cervical Spine: An Extreme Form of Pedicle Absence. European Journal of Radiology 20 (1995): 100-04.
• Oestreich, Alan E, Lionel W. Young. The Absent Cervical Pedicle Syndrome: A Case in Childhood. Department of Radiology, University of Rochester Medical Center 107.3 (1969): 505.
• O'Donnell, Chris. Bilateral Cervical Locked Facets | Radiology Case Radiopaedia.org. Radiopaedia Blog RSS. CAT Scan (CT) - Spine. CAT Scan (CT)-Spine. Radiology Society of North America, 5 June 2015.
• Guille, James T, Henry H. Sherk. Congenital Osseous Anomalies of the Upper and Lower Cervical Spine in Children. The Journal of Bone and Joint Surgery 84 - A (2002): 277-88. JBJS.org. Feb. 2002.
• Cox, Harrell E, William F. Computed Tomography of Absent Cervical Pedicle. Journal of Computer Assisted Tomography 8.3 (1984): 537-39.
• Lauten, Gregory J, William D. Computed Tomography in Absent Cervical Pedicle. American Journal of Roentgenology 1 (1980):201-03.
• Oh, Young-Min, Jong-Pil Eun, Eun-Jeong Koh, Ha-Young Choi. Posterior Arch Defects of the Cervical Spine: A Comparison between Absent Pedicle Syndrome and Spondylosis. Spine Journal (2009): 1-5.
• Goel, Ayush. Locked Facet Joint | Radiology Case Reference Article Radiopaedia.org. Radiopaedia Blog RSS. To submit your manuscript, please click on http://ulutasmedicaljournal.com