Suzuki Teppei, Miyamoto Hiroshi, Sumi Masatoshi, Inui Yoshihiro, Uno Koki, Takabatake Masato, Tadokoro Kou
Department of Orthopedic Surgery, National Hospital Organization Kobe Medical Center, Kobe, Japan.
J Spinal Disord Tech. 2008 May;21(3):225-8. doi: 10.1097/BSD.0b013e318074e4e3.
Case report.
Cervical myelopathy caused by osteophyte formation appearing at the pseudoarthrosis between the posterior arch of the atlas and the lamina of the axis is extremely rare. To our knowledge, only 2 cases in non-Klippel-Feil syndrome have been reported so far.
A 61-year-old man, who was diagnosed as Klippel-Feil syndrome with assimilation between C2 and C3 vertebrae, which were fused in hyperlordosis, suffered cervical myelopathy. Complete bipartition of the atlas was also demonstrated. Massive osteophytes, which severely compressed the spinal cord at the pseudoarthrosis between the posterior arch of the atlas and the lamina of the axis, were seen. Surgical resection of the osteophytes was performed.
The patient had significant clinical improvement after posterior resection of the osteophytes.
Coincidence of several bony anomalies such as assimilation of C2 and C3, which were fused in hyperlordosis, and the bipartition of the atlas may biomechanically influence the formation of pseudoarthrosis between the posterior arch of the atlas and the lamina of the axis. Because symptoms appeared in the patient's 60s despite congenital bony anomaly, degeneration might contribute to the formation of massive osteophytes. Posterior decompression was effective in this case.
病例报告。
寰椎后弓与枢椎椎板间假关节处骨赘形成导致的颈椎脊髓病极为罕见。据我们所知，迄今为止，非克利珀尔-费尔综合征中仅报道过2例。
一名61岁男性，被诊断为克利珀尔-费尔综合征，C2和C3椎体融合并呈过度前凸，患有颈椎脊髓病。还发现寰椎完全二分。可见大量骨赘，在寰椎后弓与枢椎椎板间的假关节处严重压迫脊髓。对骨赘进行了手术切除。
患者在骨赘后路切除术后临床症状有显著改善。
C2和C3融合并呈过度前凸等多种骨骼异常与寰椎二分同时存在，可能在生物力学上影响寰椎后弓与枢椎椎板间假关节的形成。尽管存在先天性骨骼异常，但患者在60多岁时出现症状，退变可能促使大量骨赘形成。在该病例中，后路减压有效。
