Congenital Cervical Spondyloptosis in the Neonate: A Prenatal Diagnosis.

Congenital spine abnormalities are rare in the fetus and neonate. The illustrative case described in this article is unique as it depicts a neonate with prenatally diagnosed cervical spondyloptosis. Vertebral instability at any level of the spine, regardless of its etiology, is dangerous as it has the potential for neurologic involvement-making an early diagnosis and treatment paramount. Proper stabilization in the delivery room, transfer to the neonatal intensive care unit, and establishment of a multidisciplinary treatment plan are the mainstays of therapy. Diagnosis is usually obtained through computed tomography and magnetic resonance imaging performed during the fetal or, more commonly, neonatal period. Successful management is often accomplished in consultation with different pediatric subspecialists, particularly orthopedists and neurosurgeons. The definitive therapy is surgical intervention. Prognosis of this condition is dependent upon the severity of the malformation, time to stabilization, successful orthopedic and neurosurgical intervention, and proper adherence to follow-up. [Pediatr Ann. 2020;49(7):e313-e318.].

Congenital double-level cervical spondylolysis: a case report and review of the literature.

PURPOSE: We report a rare Japanese female who was affected with three genetic-linked diseases: double-level cervical bilateral spondylolysis in association with spina bifida occulta, cleft lip and monostotic fibrous dysplasia of the right proximal femur. The case was considered to be congenital in origin. We also review the pertinent literature of cervical spondylolysis, with a focus on the pathogenesis of multiple-level cervical spondylolysis. METHODS: A 40-year-old female presented with progressive clumsiness and numbness of the hands. Japanese Orthopedic Association (JOA) score for the cervical spine was 14.5. Plain radiographs of the cervical spine showed bilateral spondylolysis of the articular mass portion, with an adjacent dysplastic change and spina bifida occulta of C4 and C5. Cervical laminoplasty from C4 to C6 was performed. RESULTS: The postoperative course was uneventful, and the patient had some recovery of muscle power and sensation, with JOA score improving to 15.5. At the 8-year follow-up, the patient had no recurrence of symptoms, but did show kyphotic and degenerative changes at the C4/5 and C5/6 level with no apparent instability. CONCLUSIONS: This case is a rare presentation of bilateral cervical spondylolysis involving C4 and C5, presumably congenital, accompanied by combined dysplastic changes of the cervical spine, cleft lip, and fibrous dysplasia, possibly through an error involving an ossification center during the embryonic stage.

Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-up.

OBJECT: Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist. METHODS: The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2-3 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded. RESULTS: The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2-3 angulation, displacement, and width of pars defect were measured when available. The mean C2-3 angulation was 9.5° (range 1-34°), the mean C2-3 displacement was 4.78 mm (range 1.1-10.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9-7 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14-120 months). CONCLUSIONS: Based on the literature and the authors' own experience, they conclude that most very young children with C-2 spondylolysis remain neurologically intact and maintain stability in long-term follow-up despite the bony defect. This defect is often an asymptomatic incidental finding and may be managed conservatively. More aggressive therapy including surgery is indicated for those patients with a neurological deficit from spinal cord compromise secondary to stenosis and local C-2 kyphosis, progressive deformity, or worsening C2-3 instability.

Congenital absence of the lumbar facet joint associated with bilateral spondylolysis of the fifth lumbar vertebra.

A 14-year-old boy presented with a rare case of congenital absence of lumbar facet joint manifesting as low back pain. Physical examination showed no neurological or hematologic abnormalities. Radiography revealed absence of a facet joint on the right side of L4-5. Computed tomography and three-dimensional computed tomography revealed absence of the facet joint on the right side of L4-5 and spondylolysis on both sides of L5. Pain subsided after conservative treatment. This is an extremely rare case of congenital absence of lumbar facet joint associated with bilateral spondylolysis.

Cervical spondylolysis: a case report.

Cervical spondylolysis is defined as a corticated cleft between the superior and inferior articular facets of the articular pillar, the cervical equivalent of the pars interarticularis in the lumbar spine. Of primary importance is its recognition to avoid confusion with more clinically significant abnormalities such as fracture or dislocation. This case report describes bilateral spondylolysis and associated dysplasia of C5 in a 31-year-old female. We describe the radiographic presentation of this anomaly, stressing the importance of computed tomography for correct diagnosis. A review of the literature on this interesting abnormality and a complete differential diagnosis are presented.

Congenital spondylolysis of the axis with associated myelopathy. Case report.

Cervical spondylolysis is a rare clinical entity and occurs predominantly at the C-6 level. The authors describe a patient with congenital spondylolysis of the axis that caused myelopathy. The patient was a 57-year-old woman with long-standing gait disturbance. Plain cervical radiography revealed a radiolucent defect across the pedicle of the axis. Magnetic resonance imaging of the cervical spine in the neutral, flexion, and extension neck positions as well as a computerized tomography myelography in the neutral neck position failed to demonstrate any spinal cord compression. When she rotated her neck, however, the spinal cord was caught between the hypertrophic anterior arch of the atlas and posterior part of the slipped pedicle of the axis on the contralateral side. The spinal cord was transformed into a pear shape. Mechanical injury to the spinal cord seemed to explain her neurological presentation. This is, to the authors' knowledge, the 15th case of axial spondylolysis and the sixth case of spinal cord involvement of the cervical spondylolysis. No cases involving myelopathy secondary to such a unique mechanism have been reported previously in the literature.

Cervical spondylolysis: three levels of simultaneous involvement.

OBJECTIVE: To discuss an interesting case depicting multiple levels of cervical spondylolysis. Differential diagnosis and a brief review of the literature are discussed. CLINICAL FEATURES: A 24-yr-old man suffered from constant neck discomfort of approximately 4 months' duration. After physical examination, X-rays were performed and revealed multiple congenital anomalies. The patient's symptoms are considered independent of the radiographic findings. INTERVENTION AND OUTCOME: This patient was successfully treated with conservative chiropractic management and experienced complete resolution of his presenting symptoms. CONCLUSION: This case nicely demonstrates the congenital nature of cervical spondylolysis. It is unusual in that no prior case report has described three levels of involvement. The spondylolysis and other changes of the neural arch should not be confused with fracture.

[Cervical spondylolysis in children. Apropos of 4 cases. Review of the literature]. / La spondylolyse cervicale chez l'enfant. A propos de 4 cas. Revue de la litterature.

PURPOSE OF THE STUDY: A clinical and radiological study of four cases of spondylolysis in children. Literature review shows the congenital origin of the disorder and how it is to be treated. MATERIAL AND METHODS: We report on four children with cervical spondylolysis. One of the children presented a two-level spondylolysis C5C6. One case was totally asymptomatic and was hazardly discovered. Standard radiographs were used for diagnosis. Conservative treatment was administered in all cases and all patients were immobilized for a few days. DISCUSSION: It has been clearly established that cervical spondylolysis is a congenital disorder often associated with other anomalies: spina bifida, dysplasia of the posterior articular processes. In the child, cervical spondylolysis is only discovered in fifty per cent of Post traumatic cases. The most frequent finding is at C6. A diagnosis can be made based on the radiographs and the CT scan. MRI will only be indicated in spondylolisthesis in order to analyze the disc statement and the degree of canal narrowing. When possible conservative treatment should be adopted. Arthrodesis is reserved for unstable and painful lesions. CONCLUSION: Cervical spondylolysis in the child is a rare congenital disorder. It must be distinguished from the congenital absence of a pedicle and from a pedicle or isthmic fracture. It is a lesion which is normally discovered once the patient has turned adult and is very well long term tolerated.

Case report 868. Congenital bilateral spondylolysis and spondylolisthesis of the fourth cervical vertebra.

A case of congenital bilateral spondylolysis of fourth cervical vertebra was reported and the characteristic radiological features shown. Although the diagnosis is often suggested by the plain films, demonstration of the typical CT findings is often necessary to reach a final diagnosis. Awareness of this entity and its specific radiological features will help to differentiate this relatively benign cervical anomaly from other, more ominous, unstable causes of cervical spondylolisthesis such as those related to acute cervical injury. It may also prevent any inappropriate treatment from being undertaken.

Congenital laminar defect of the upper lumbar spine associated with pars defect. A report of eleven cases.

Lumbar spondylolysis generally is considered to be a fatigue fracture of the pars interarticularis, and no unequivocal case of congenital spondylolysis has been reported. The authors describe 11 cases of unilateral spondylolysis (possibly congenital laminar defect associated with pars defect) of the upper lumbar spine. They have roentgenographic characteristics distinct from conventional spondylolysis of the lumbar spine, including hypoplasia of the spinal accessory process, rotation of the spinous process contralaterally to the spondylolysis, and prominent ipsilateral lamina. The anomaly found in these 11 patients probably is congenital, and its clinical significance is not known.

Congenital fusion C0-C2 associated with spondylolysis of C2.

This is the report of a very rare malformation at the cranio-cervical junction, including congenital occipito-cervical fusion C0-C2, spondylolysis of C2, and hypoplasia of the right vertebral artery. The malformation itself is part of a Klippel-Feil syndrome with sensory-neural hearing loss on the left side, congenital high thoracic scoliosis, rib agenesis on the right side, and kidney malformations on both sides.

Posterior arch defects of the cervical spine.

Spondylolysis and absence of the pedicle are congenital anomalies of the posterior cervical spine. Their roentgenographic changes may be confused with other more serious entities which may necessitate either emergent therapy or require extensive diagnostic testing and treatment. Four cases are present and the literature is reviewed. A hypothesis for the embryologic etiology of these entities is proposed.