| Cervical myelopathy associated with congenital C2/3 canal stenosis and deficiencies of the posterior arch of the atlas and laminae of the axis: case report and review of the literature. | |
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MedLine Citation:
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PMID: 19910758 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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STUDY DESIGN: A case report of a young male suffering progressive neurologic dysfunction associated with a previously unreported combination of structural bony abnormalities. A review of the literature is also presented. OBJECTIVE: To describe a unique presentation of cervical myelopathy related to posterior deficiencies of the atlas and axis, and to report on the successful management of this case. SUMMARY OF BACKGROUND DATA: Cervical myelopathy from congenital canal stenosis is an uncommon presentation in the adolescent age group, especially affecting the C2/3 level. Aplasia of the atlas is a rare, although well-reported phenomena. Defects of the posterior elements of the axis are similarly uncommon. A combination of the 2 defects in the 1 patient has not previously been recorded. METHODS: A 14-year-old Caucasian male with no history of trauma or neck pain presented with progressive cervical myelopathy over a 2-year period. Plain radiograph and computed tomography revealed congenital aplasia of the posterior arch of the atlas and bilateral cleft defects of the laminae of the axis resulting in a free floating C2 spinous process. Magnetic resonance imaging showed T1 and T2 signal abnormality at the C2-C3 level, with C2/3 congenital canal stenosis and mild disc protrusion. RESULTS: The patient underwent a posterior decompression and lateral mass fixation at the C2/3 articulation to preserve maximal motion segments. At 12-month follow-up, the patient's cervical myelopathy had improved in terms of gait dysfunction and hemiparesis. Fusion was evident across the posterior lateral mass on radiologic investigation. CONCLUSION: Posterior deficiencies of the atlas and axis are rare occurrences in isolation, let alone in the 1 patient. This report broadens the radiographic differential diagnosis of patients presenting with cervical myelopathy, which has been associated with congenital posterior C2 anomalies in only a handful of patients. Surgery is an appropriate option for these patients faced with progressive neurologic dysfunction. |
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Authors:
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Anthony Minh Tien Chau; Johnny Ho-Yin Wong; Ralph Jasper Mobbs |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Spine Volume: 34 ISSN: 1528-1159 ISO Abbreviation: Spine Publication Date: 2009 Nov |
Date Detail:
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Created Date: 2009-11-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7610646 Medline TA: Spine (Phila Pa 1976) Country: United States |
Other Details:
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Languages: eng Pagination: E886-91 Citation Subset: IM |
Affiliation:
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University of New South Wales, and Department of Neurosurgery, Spine Unit, Prince of Wales Hospital, Sydney, Australia. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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