DOI QR코드

DOI QR Code

A Concomitant Occurrence of the Atlantoaxial Subluxation with Rare Vertebral Formation and Segmentation Defects

  • Choi, Man Kyu (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Kim, Sung Bum (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine) ;
  • Lee, Jun Ho (Department of Neurosurgery, Kyung Hee University Hospital, Kyung Hee University College of Medicine)
  • 투고 : 2020.10.12
  • 심사 : 2021.01.27
  • 발행 : 2021.09.01

초록

An atlantoaxial subluxation from the unstable Os odontoideum by the failure of proper integrations between the embryological somites might be a commonly reported pathology. However, its suspicious origin or paralleled occurrence with other congenital anomalies of vertebral body might be a relatively rare phenomenon. The authors present two cases, who simply presented with clinical signs of prolonged, intractable cervicalgia without any neurological deficits, revealed this rare feature of C1-2 subluxation from the unstable, orthotropic type of Os odontoideum that coincide with congenitally fused cervical vertebral bodies between C2-3. Surprisingly, in one case, when traced from the lower cervical down to the thoracic-lumbar levels during the preoperative work-up process, was also compromised with multi-level butterfly vertebrae formations. Presented cases highlight the association of various congenital vertebrae anomalies and the rationale to fuse only affected joints.

키워드

참고문헌

  1. Cave P : Butterfly vertebra. Br J Radiol 31 : 503-506, 1958 https://doi.org/10.1259/0007-1285-31-369-503
  2. Colquhoun J : Butterfly vertebra or sagittal cleft vertebra. Am J Orthop Surg 10 : 44-50, 1968
  3. Deepak AN, Salunke P, Kamble RP : Case of atlantoaxial dislocation with assimilated C1, absent posterior C2, butterfly C3, and fused subaxial cervical spine: management dilemma with multiple segmentation and formation defects. J Pediatr Neurosci 12 : 72-74, 2017 https://doi.org/10.4103/jpn.JPN_154_16
  4. Gray SW, Romaine CB, Skandalakis JE : Congenital fusion of the cervical vertebrae. Surg Gynecol Obstet 118 : 373-385, 1964
  5. Jain N, Verma R, Garga UC, Baruah BP, Jain SK, Bhaskar SN : CT and MR imaging of odontoid abnormalities: a pictorial review. Indian J Radiol Imaging 26 : 108-119, 2016 https://doi.org/10.4103/0971-3026.178358
  6. Katsuura Y, Kim HJ : Butterfly vertebrae: a systematic review of the literature and analysis. Global Spine J 9 : 666-679, 2019 https://doi.org/10.1177/2192568218801016
  7. McRae DL, Barnum AS : Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med 70 : 23-46, 1953
  8. Muller F, O'Rahilly R, Benson DR : The early origin of vertebral anomalies, as illustrated by a 'butterfly vertebra'. J Anat 149 : 157-169, 1986
  9. Pang D, Thompson DN : Embryology and bony malformations of the craniovertebral junction. Childs Nerv Syst 27 : 523-564, 2011 https://doi.org/10.1007/s00381-010-1358-9
  10. Patcas R, Tausch D, Pandis N, Manestar M, Ullrich O, Karlo CA, et al. : Illusions of fusions: assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs. Am J Orthod Dentofacial Orthop 143 : 213-220, 2013 https://doi.org/10.1016/j.ajodo.2012.09.017
  11. Patinharayil G, Han CW, Marthya A, Meethall KC, Surendran S, Rudrappa GH : Butterfly vertebra: an uncommon congenital spinal anomaly. Spine (Phila Pa 1976) 33 : E926-E928, 2008 https://doi.org/10.1097/BRS.0b013e31818ad3e1
  12. Patra DP, Salunke P, Pramanick G : Butterfly C2 vertebra: an unusual finding in a case of os odontoideum. Pediatr Neurosurg 49 : 320- 323, 2013 https://doi.org/10.1159/000367664
  13. Salunke P, Behari S, Kirankumar MV, Sharma MS, Jaiswal AK, Jain VK : Pediatric congenital atlantoaxial dislocation: differences between the irreducible and reducible varieties. J Neurosurg 104(2 Suppl) : 115-122, 2006
  14. Salunke P, Sharma M, Sodhi HB, Mukherjee KK, Khandelwal NK : Congenital atlantoaxial dislocation: a dynamic process and role of facets in irreducibility. J Neurosurg Spine 15 : 678-685, 2011 https://doi.org/10.3171/2011.7.SPINE1152
  15. Shah A, Kaswa A, Jain S, Goel A : Atlantoaxial instability associated with pan cervical vertebral fusion: report on management of 4 cases. Neurol India 66 : 147-150, 2018 https://doi.org/10.4103/0028-3886.222853
  16. Smoker WR : Congenital anomalies of the cervical spine. Neuroimaging Clin N Am 5 : 427-449, 1995
  17. Yang SY, Boniello AJ, Poorman CE, Chang AL, Wang S, Passias PG : A review of the diagnosis and treatment of atlantoaxial dislocations. Global Spine J 4 : 197-210, 2014 https://doi.org/10.1055/s-0034-1376371
  18. Yin HF, Yang KQ, Lou SQ : Clinical significance of congenital fusion of cervical vertebrae: a report of 87 cases. Zhonghua Wai Ke Za Zhi 27 : 75-77, 124, 1989