Congenital atlantoaxial block vertebra A Case Report I[y S. S01tolttt. and 0. lrtgonrds~n
Key words Atlaiitoaxial fusion -Block vei-tcbra
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Fig. 1 Lateral view of the cervical spine showing blockverlebra ofC1-C2
Corigenital anonialy
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Schlüsselwörter Atlariloaxiale Fusion - Korigeriitale A n o malie - Blockwirbctl
Iii primatcs the craniovertebrnl junction is an enibryologically uristahle region with a broad spectruni of anorrialies. Thcsc craniocervical anoinalics arc known to caiise diagnostic pruhleiiis espccially in cases witli concomitant trauma Thc conditiori oiatlantoaxial Fusion with the formation of a block vertebra constitutes an extrernely rarc anomaly ol' nll thc many and varied rnnnifcstations of irregular segmentatiori aiiecting thc atlas and axis.
Fig. 2 Frontal tornograrn.
We present n casc of congenital fusioii or tlie ntlas and axis vertnbrac incidentally discovered i n a 12-year old boy.
Case reporl
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A 12-ycar old boy presenletl in the Emcrgoncy Roorn complaining over neck pnin following a moto-cross accident. Except for a slight torticollis. wtiich had bccn prcsent since birtli. he was previuiisly without neck syrnptoiiis. l'lie ncurological exaniination was wittiiri iiorrnnl limits. cxcept for decreased rotation rnotion ol' thc hcad when ttir lower ccrvical spine was restricted.
Radiological exaiiiination of thc cervical spine (Fig. 1-3) includirig frontal and lateral tornograpliy demonstratcd a Cl--C2 block vertebra, which was placcd obliquely with relntion to the rest of the cnrvical spine. The anterior arch of the atlas was assimilated with tlie dens. which appeared liypoplastic. Thc body nf the axis was fusioned witli the latcral masses o l ttie atlas. 'l'hn oblique position of thc head was diie to nsymrnctry of the axis which had its major rriass on thc right side and oiily a minor mass on the left sidc thus resernbliiig n hemivcrtcbra. i'he lelt lairiiiin 01' the axis was nbsent whereas the riglit laniinn was fuscd with the postcrior arch of ttie ntlas. Thn rcst of the cervical spiiie was without malforinations. -. ... .
Forlschr. Röntgenstr. 153.3 (1990) 351 -352 O tieorgTtiieirieVerlagStuttgar1~NewYork
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Fig. 3 Schematic drawingof the tomogram in Fig. 2 A) axis, B) processus transversus atlantis, C) corpus atlantis. D)densepistrophei, E) thirdce~ical verlebra, F) occipital condyles.
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
I ~ ~ p i i r t r i i rof t i tDiagnostic Hadiology I Ijoi.ring I lospital. Iknniark
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Srgrrieiilalioii nbnormalitics of the cervical spiric! occiir ~ i i t l both i hcmivertebral tleforinilies and vcrtical fusion of various degrees ( I , 4. 7). Wc consider thv dcscribad niiomnly to bc n caso of congrnital ellaiitnaxial fusion and irregiilar st!giiit:iiinlioii Accurding to ihrklus and I;el?lr (4) sucli aii al.laiitoexinl lusiori givcs risc! to aii uiiilicd wholr. a socalled "Atlas,Luis". cliarac:trriscd by thc absence ur t l i i l nnlcrior arch of thr ;lllns. I n additiuii tlie tleiis is citlicr Iiypoplastic or üplnsiic. Iii ilie prcsc:ntod casc thc axis apprilred as a Iiciiiivcrtcbra. which rnost probably wiis dua to irrcgular scgmcntatioii ofthr: axis. Consistcnt with this tlie Ipfiatlaiilo-c:oiidylarjoinlwas displaced I>yoiie-liall'ol' ;Lsegriiciit. aiid thc displaretl joiiil. a1)pcarcd with horizoiital joini surfacc?~. As already poirited oiit i n sevcral rcports (2. 3.4.
5, 6. 7). the forriinlioii of thc block vertebra resiills i r i the f'ormation
.Y Solrol~tr,artd 0. lnqunrdsen (,~ongcrr~rc~l atlantoax~al block urrlebrtr .
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f:nac?, /I.. I . f;'.: On hsion ol'ihc Al.lns arid Axis vcrinl)rnrs. . I . Aiiat 04 (1930) 337 ,.343 Gicndrrsotr. 6'. A.. H. I,'. 7'nddonio: (:ongc:nital atlaritoaxial fusinn: A c:asc rcport. Spiiic: 4 (1979) 9 - 1 1 O//I~~LIL/~, A'., .Y. P. Buhrf~r:Fiisiuii uf ihc. aliterior arcli oV LIic! al.las and dcns. Skcletal tiadiol. 12 ('I984) 2 1-22 troii 'l'orklrcs, D., M'. (;C/I/P: Dia ol)cia I l n l ~ \ ~ i r h c l s ~First i ~ l (i?di~. tioii. Tliic:iiic*. Stui.lgart 1975 M'ackrtrheirn. A . : L)c!nsaplasia \vith atlantoaxial fusion. A spccial and stablc i'nrm ol' dcnsnplnsin. Ncurorndiology 2 ('IO71) 70-79 Ll'ockenhrir~~. il.: (:I -(:2 block vcrtcbra. Ncuroradiolog~~I 6 ( 1978) 41 0 . 4'17 M'crc.kenh.c!lrrr. /I,: Iloc!iilgeri diagncisis of t l i c ! criiiiiovrrt.t~braIr r gion. First cdition. Springer Vcrlag. Ucrlin-Hcidclbcrg-Ncw York 1974
ol'n t~inctionallystable coiiliguration without instability. Iiitlie prcscntcd case the only cliiiical lindinp wns
Key words Atlaiitoaxial fusion -Block vei-tcbra
--
-.
Fig. 1 Lateral view of the cervical spine showing blockverlebra ofC1-C2
Corigenital anonialy
-
Schlüsselwörter Atlariloaxiale Fusion - Korigeriitale A n o malie - Blockwirbctl
Iii primatcs the craniovertebrnl junction is an enibryologically uristahle region with a broad spectruni of anorrialies. Thcsc craniocervical anoinalics arc known to caiise diagnostic pruhleiiis espccially in cases witli concomitant trauma Thc conditiori oiatlantoaxial Fusion with the formation of a block vertebra constitutes an extrernely rarc anomaly ol' nll thc many and varied rnnnifcstations of irregular segmentatiori aiiecting thc atlas and axis.
Fig. 2 Frontal tornograrn.
We present n casc of congenital fusioii or tlie ntlas and axis vertnbrac incidentally discovered i n a 12-year old boy.
Case reporl
.
--
-
A 12-ycar old boy presenletl in the Emcrgoncy Roorn complaining over neck pnin following a moto-cross accident. Except for a slight torticollis. wtiich had bccn prcsent since birtli. he was previuiisly without neck syrnptoiiis. l'lie ncurological exaniination was wittiiri iiorrnnl limits. cxcept for decreased rotation rnotion ol' thc hcad when ttir lower ccrvical spine was restricted.
Radiological exaiiiination of thc cervical spine (Fig. 1-3) includirig frontal and lateral tornograpliy demonstratcd a Cl--C2 block vertebra, which was placcd obliquely with relntion to the rest of the cnrvical spine. The anterior arch of the atlas was assimilated with tlie dens. which appeared liypoplastic. Thc body nf the axis was fusioned witli the latcral masses o l ttie atlas. 'l'hn oblique position of thc head was diie to nsymrnctry of the axis which had its major rriass on thc right side and oiily a minor mass on the left sidc thus resernbliiig n hemivcrtcbra. i'he lelt lairiiiin 01' the axis was nbsent whereas the riglit laniinn was fuscd with the postcrior arch of ttie ntlas. Thn rcst of the cervical spiiie was without malforinations. -. ... .
Forlschr. Röntgenstr. 153.3 (1990) 351 -352 O tieorgTtiieirieVerlagStuttgar1~NewYork
..
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Fig. 3 Schematic drawingof the tomogram in Fig. 2 A) axis, B) processus transversus atlantis, C) corpus atlantis. D)densepistrophei, E) thirdce~ical verlebra, F) occipital condyles.
Dieses Dokument wurde zum persönlichen Gebrauch heruntergeladen. Vervielfältigung nur mit Zustimmung des Verlages.
I ~ ~ p i i r t r i i rof t i tDiagnostic Hadiology I Ijoi.ring I lospital. Iknniark
-
--
-
Srgrrieiilalioii nbnormalitics of the cervical spiric! occiir ~ i i t l both i hcmivertebral tleforinilies and vcrtical fusion of various degrees ( I , 4. 7). Wc consider thv dcscribad niiomnly to bc n caso of congrnital ellaiitnaxial fusion and irregiilar st!giiit:iiinlioii Accurding to ihrklus and I;el?lr (4) sucli aii al.laiitoexinl lusiori givcs risc! to aii uiiilicd wholr. a socalled "Atlas,Luis". cliarac:trriscd by thc absence ur t l i i l nnlcrior arch of thr ;lllns. I n additiuii tlie tleiis is citlicr Iiypoplastic or üplnsiic. Iii ilie prcsc:ntod casc thc axis apprilred as a Iiciiiivcrtcbra. which rnost probably wiis dua to irrcgular scgmcntatioii ofthr: axis. Consistcnt with this tlie Ipfiatlaiilo-c:oiidylarjoinlwas displaced I>yoiie-liall'ol' ;Lsegriiciit. aiid thc displaretl joiiil. a1)pcarcd with horizoiital joini surfacc?~. As already poirited oiit i n sevcral rcports (2. 3.4.
5, 6. 7). the forriinlioii of thc block vertebra resiills i r i the f'ormation
.Y Solrol~tr,artd 0. lnqunrdsen (,~ongcrr~rc~l atlantoax~al block urrlebrtr .
' 'I
" " "
f:nac?, /I.. I . f;'.: On hsion ol'ihc Al.lns arid Axis vcrinl)rnrs. . I . Aiiat 04 (1930) 337 ,.343 Gicndrrsotr. 6'. A.. H. I,'. 7'nddonio: (:ongc:nital atlaritoaxial fusinn: A c:asc rcport. Spiiic: 4 (1979) 9 - 1 1 O//I~~LIL/~, A'., .Y. P. Buhrf~r:Fiisiuii uf ihc. aliterior arcli oV LIic! al.las and dcns. Skcletal tiadiol. 12 ('I984) 2 1-22 troii 'l'orklrcs, D., M'. (;C/I/P: Dia ol)cia I l n l ~ \ ~ i r h c l s ~First i ~ l (i?di~. tioii. Tliic:iiic*. Stui.lgart 1975 M'ackrtrheirn. A . : L)c!nsaplasia \vith atlantoaxial fusion. A spccial and stablc i'nrm ol' dcnsnplnsin. Ncurorndiology 2 ('IO71) 70-79 Ll'ockenhrir~~. il.: (:I -(:2 block vcrtcbra. Ncuroradiolog~~I 6 ( 1978) 41 0 . 4'17 M'crc.kenh.c!lrrr. /I,: Iloc!iilgeri diagncisis of t l i c ! criiiiiovrrt.t~braIr r gion. First cdition. Springer Vcrlag. Ucrlin-Hcidclbcrg-Ncw York 1974
ol'n t~inctionallystable coiiliguration without instability. Iiitlie prcscntcd case the only cliiiical lindinp wns
