Case ReportPosterior arch defects of the cervical spine: a comparison between absent pedicle syndrome and spondylolysis
Introduction
Abnormalities of the posterior arch are rare entities that are usually found incidentally on neck radiographs. Their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. It is important to distinguish these posterior arch abnormalities from the other entities because the treatment is very different. There are two complexes of abnormalities related to posterior arch defects of the cervical spine. One is a congenital spondylolytic spondylolisthesis (spondylolysis), and the other is absent pedicle syndrome [1].
We report three cases of posterior arch defects and present a review of the literature concerning the distinguishing features between spondylolysis and absent pedicle syndrome.
Section snippets
Case 1
A 47-year-old woman was presented with posterior neck pain and right arm pain after a traffic accident. She had no history of posterior neck pain before the accident. Cervical spine films showed an enlarged neural foramen extending from C4 to C5 on the right side (Fig. 1, top left). Also, two-dimensional (2D) computed tomography (CT) showed the findings of right unilateral facet dislocation (Fig. 1, bottom left). But, three-dimensional (3D) CT scan revealed the absence of the right pedicle and
Review of the literature
Since bilateral cervical spondylolysis was first described by Perlman and Hawes [2] in 1951, only one hundred cases have been reported in the literature. Although cervical spondylolysis has been reported at all vertebral levels except C1 and C7, most reported cases have occurred at C6. The abnormality is almost always bilateral rather than unilateral and is associated with spondylolisthesis and spina bifida.
There have been fewer than one hundred published cases of absent pedicle syndrome since
Discussion
Spondylolysis and absent pedicle syndrome of the cervical spine are actually a complex of abnormalities in posterior arch development. They are similar to each other, but there are some distinctive differences between them.
Conclusion
Spondylolysis and absence of the pedicle are congenital anomalies of the posterior cervical spine. Their roentgenographic findings may be confused with other more serious entities that require either emergent therapy or extensive diagnostic testing and treatment. However, spondylolysis and absence of the pedicle have some distinctive features. These distinctive features may be helpful in confirming the diagnosis and planning treatment. Furthermore, 3D CT scan reconstruction provides
Acknowledgments
The authors thank the Department of Radiology, Chonbuk National University Medical School/Hospital for technical assistance.
References (16)
- et al.
Computed tomography of congenital spondylolisthesis of the sixth cervical vertebra
Clin Imaging
(1991) - et al.
Posterior arch defects of the cervical spine
Skeletal Radiol
(1982) - et al.
Cervical spondylolisthesis
J Bone Joint Surg Am
(1951) Congenital absence of pedicle from the cervical vertebra
AJR Am J Roentgenol
(1946)- et al.
Congenital dysplasia of C2–6
Pediatr Radiol
(1977) - et al.
Congenital absence of a cervical spine pedicle: clinical and radiographic findings
AJR Am J Roentgenol
(1990) - et al.
Congenital absence of a pedicle in the cervical spine
AJR Am J Roentgenol
(1966) - et al.
Spondylolysis and spondylolisthesis of the cervical spine
Skeletal Radiol
(1978)
Cited by (12)
A New Minimally Invasive Technique for Primary Unstable C2 Spondylolysis in an 8-Year-Old Child: A Case Report and Review of the Literature
2018, World NeurosurgeryCitation Excerpt :Posterior arch defects, including congenital absence of a cervical pedicle and cervical spondylolysis, are rare conditions usually found incidentally after minor trauma or complaints of chronic neck pain.1,2
Absent congenital cervical pedicle nearly misdiagnosed as a facet dislocation: A case report
2017, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCervical Fusion for Absent Pedicle Syndrome Manifesting with Myelopathy
2016, World NeurosurgeryCitation Excerpt :Our case demonstrates that absent pedicle syndrome can extend above the 4th cervical vertebrae, which is unique compared with other reported cases. Most patients with absent pedicle syndrome complain of cervical pain that radiates to 1 or both extremities (59%).2 Neurologic examination is normal in 65% of patients with a diagnosis of absent pedicle syndrome.2,7
Cervical congenital spondylolytic spondylolisthesis associated with duplication of the vertebral artery: Case report
2014, Spine JournalCitation Excerpt :Cervical bilateral congenital spondylolysis with spondylolisthesis is an abnormality of both congenital and mechanical origin, characterized by its primary feature, cervical bilateral spondylolysis. Cervical bilateral congenital spondylolysis, a rare disorder, is a cortical cleft between the superior and inferior articular facets of the articular pillar mainly localized at C6 [1,2,5–9], the cervical equivalent of the pars interarticularis of the lumbar spine [1,2,5,8,9]. Many other osseous malformations of the posterior arch of the cervical vertebra, including spina bifida and spondylolisthesis, have been described in association with cervical bilateral congenital spondylolysis [1,2,5–10].
Undifferentiated presentation of unilateral agenesis of a cervical pedicle and a contiguous vertebral hemangioma: illustrative case
2022, Journal of Neurosurgery: Case Lessons
FDA device/drug status: not applicable.
Author disclosures: none.