Skip to main content

Advertisement

SpringerLink
Log in

Congenital variations of the upper cervical spine and their importance in preoperative diagnosis. A case report and a review of the literature

  • Up-to date Review and Case Report
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Several variations of the bony and vascular anatomy around the first and second cervical vertebrae have been reported. Failure to recognise these variations can complicate operations on the upper cervical spine. We present a patient with recent onset of cervical myelopathy due to stenosis at the C3–4 level. Preoperative evaluation identified Klippel-Feil syndrome with cervical fusion of C2–3, aplasia of posterior arch of C1, anomalous vertebral artery course and a “ponticulus posticus” of C2. The combination of these variations in a Klippel-Feil syndrome patient has never been reported. Thus, we recommend a thorough preoperative imaging evaluation, with CT scan and CT angiography or DSA, in addition to plain radiographs. This evaluation is imperative, before a cervical spine surgery, allowing a better understanding of the anatomy, in order to minimise the risks of misplacement of cervical instrumentation especially in such patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Terterov S, Taghva A, Khalessi AA, Hsieh PC (2011) Symptomatic vertebral artery compression by the rod of a C1–C2 posterior fusion construct: case report and review of the literature. Spine (Phila Pa 1976) 36(10):E678–E681. doi:10.1097/BRS.0b013e3181faa6de

    Article  Google Scholar 

  2. Paramore CG, Dickman CA, Sonntag VK (1996) The anatomical suitability of the C1–2 complex for transarticular screw fixation. J Neurosurg 85(2):221–224. doi:10.3171/jns.1996.85.2.0221

    Article  PubMed  CAS  Google Scholar 

  3. Igarashi T, Kikuchi S, Sato K, Kayama S, Otani K (2003) Anatomic study of the axis for surgical planning of transarticular screw fixation. Clin Orthop Relat Res 408:162–166

    Article  PubMed  Google Scholar 

  4. Uchino A, Saito N, Watadani T, Okada Y, Kozawa E, Nishi N, Mizukoshi W, Inoue K, Nakajima R, Takahashi M (2012) Vertebral artery variations at the C1–2 level diagnosed by magnetic resonance angiography. Neuroradiology 54(1):19–23. doi:10.1007/s00234-011-0849-z

    Article  PubMed  Google Scholar 

  5. Villas-Tomé C (2013) Congenital abnormalities. In: Korres DS (ed) Axis vertebra. Springer-Verlag, Heidelberg

    Google Scholar 

  6. Hong JT, Lee SW, Son BC, Sung JH, Yang SH, Kim IS, Park CK (2008) Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. J Neurosurg Spine 8(3):230–236. doi:10.3171/SPI/2008/8/3/230

    Article  PubMed  Google Scholar 

  7. Young JP, Young PH, Ackermann MJ, Anderson PA, Riew KD (2005) The ponticulus posticus: implications for screw insertion into the first cervical lateral mass. J Bone Joint Surg Am 87(11):2495–2498. doi:10.2106/JBJS.E.00184

    Article  PubMed  Google Scholar 

  8. Goel A, Laheri V (1994) Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien) 129(1–2):47–53

    Article  CAS  Google Scholar 

  9. Harms J, Melcher RP (2001) Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26(22):2467–2471

    Article  CAS  Google Scholar 

  10. Samartzis DD, Herman J, Lubicky JP, Shen FH (2006) Classification of congenitally fused cervical patterns in Klippel-Feil patients: epidemiology and role in the development of cervical spine-related symptoms. Spine (Phila Pa 1976) 31(21):798–804. doi:10.1097/01.brs.0000239222.36505.46

    Article  Google Scholar 

  11. Guille JT, Miller A, Bowen JR, Forlin E, Caro PA (1995) The natural history of Klippel-Feil syndrome: clinical, roentgenographic, and magnetic resonance imaging findings at adulthood. J Pediatr Orthop 15(5):617–626

    Article  PubMed  CAS  Google Scholar 

  12. Nagib MG, Maxwell RE, Chou SN (1985) Klippel-Feil syndrome in children: clinical features and management. Childs Nerv Syst 1(5):255–263

    Article  PubMed  CAS  Google Scholar 

  13. Warner W (2002) Pediatric cervical spine. Campbell’s operative orthopaedics, Tenth edn. Mosby, St Louis

  14. Klippel M, Feil A (1912) Un cas d’absence des vertebres cervicales. Avec cage thoracique remontant jusqu’a la base du crane (cage thoracique cervicale). Nouv Iconog Salpetriere 25:223–250

    Google Scholar 

  15. Shen FH, Samartzis D, Herman J, Lubicky JP (2006) Radiographic assessment of segmental motion at the atlantoaxial junction in the Klippel-Feil patient. Spine (Phila Pa 1976) 31(2):171–177

    Article  Google Scholar 

  16. Feil A (1919) L’absebce et la diminuation des vertebres cervicales (etude cliniqueet pathogenique): le syndrome dereduction numerique cervicales. Theses de Paris

  17. Wang S, Wang C, Passias PG, Yan M, Zhou H (2010) Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2–3 fusion patients? Eur Spine J 19(8):1306–1311. doi:10.1007/s00586-010-1418-6

    Article  PubMed  Google Scholar 

  18. Senoglu M, Safavi-Abbasi S, Theodore N, Bambakidis NC, Crawford NR, Sonntag VK (2007) The frequency and clinical significance of congenital defects of the posterior and anterior arch of the atlas. J Neurosurg Spine 7(4):399–402. doi:10.3171/SPI-07/10/399

    Article  PubMed  Google Scholar 

  19. Currarino G, Rollins N, Diehl JT (1994) Congenital defects of the posterior arch of the atlas: a report of seven cases including an affected mother and son. AJNR Am J Neuroradiol 15(2):249–254

    PubMed  CAS  Google Scholar 

  20. Chau AM, Wong JH, Mobbs RJ (2009) 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. Spine (Phila Pa 1976) 34(24):E886–E891. doi:10.1097/BRS.0b013e3181b64f0a

    Article  Google Scholar 

  21. Menezes AH (2007) Hypoplasia of C-1 in children with Down syndrome. J Neurosurg 107(6 Suppl):455–456. doi:10.3171/PED-07/12/455

    PubMed  Google Scholar 

  22. Vaiman M, Beckerman I, Eviatar E (2011) Detection of anomalous vertebral arteries by ultrasound as an alternative to radiological methods. Eur Arch Otorhinolaryngol 268(12):1813–1816. doi:10.1007/s00405-011-1549-3

    Article  PubMed  Google Scholar 

  23. Bruneau M, Cornelius JF, Marneffe V, Triffaux M, George B (2006) Anatomical variations of the V2 segment of the vertebral artery. Neurosurgery 59 (1 Suppl 1):ONS20-24; discussion ONS20-24. doi:10.1227/01.NEU.0000219931.64378.B5

  24. Hong JT, Park DK, Lee MJ, Kim SW, An HS (2008) Anatomical variations of the vertebral artery segment in the lower cervical spine: analysis by three-dimensional computed tomography angiography. Spine (Phila Pa 1976) 33(22):2422–2426. doi:10.1097/BRS.0b013e31818938d1

    Article  Google Scholar 

  25. Tokuda K, Miyasaka K, Abe H, Abe S, Takei H, Sugimoto S, Tsuru M (1985) Anomalous atlantoaxial portions of vertebral and posterior inferior cerebellar arteries. Neuroradiology 27(5):410–413

    Article  PubMed  CAS  Google Scholar 

  26. Pyo J, Lowman RM (1959) The ponticulus posticus of the first cervical vertebra. Radiology 72(6):850–854

    PubMed  CAS  Google Scholar 

  27. Kendrick GS, Biggs NL (1963) Incidence of the ponticulus posticus of the first cervical vertebra between ages six to seventeen. Anat Rec 145:449–453

    Article  PubMed  CAS  Google Scholar 

  28. Korres DS, Nikolopoulos KS (1999) Anatomy. Vascular elements. In: Korres DS (ed) Cevical spine. 1st edn. Medical Editions Litsas, Athens (in Greek)

  29. Krishnamurthy A, Nayak SR, Khan S, Prabhu LV, Ramanathan LA, Ganesh Kumar C, Prasad Sinha A (2007) Arcuate foramen of atlas: incidence, phylogenetic and clinical significance. Rom J Morphol Embryol 48(3):263–266

    PubMed  CAS  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. 3rd Orthopaedic Department, University of Athens, KAT Hospital, 2 Nikis Str., 14561, Kifissia, Athens, Greece

    Kalliopi Lampropoulou-Adamidou, Michael Athanassacopoulos, Panagiotis K. Karampinas, John Vlamis & Spiros G. Pneumaticos

  2. Faculty of Medicine, School of Health Sciences, University of Athens, Athens, Greece

    Demetrios S. Korres

Authors
  1. Kalliopi Lampropoulou-Adamidou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Athanassacopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Panagiotis K. Karampinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. John Vlamis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Demetrios S. Korres
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Spiros G. Pneumaticos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kalliopi Lampropoulou-Adamidou.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lampropoulou-Adamidou, K., Athanassacopoulos, M., Karampinas, P.K. et al. Congenital variations of the upper cervical spine and their importance in preoperative diagnosis. A case report and a review of the literature. Eur J Orthop Surg Traumatol 23 (Suppl 1), 101–105 (2013). https://doi.org/10.1007/s00590-013-1216-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-013-1216-z

Keywords

Search

Navigation