C2 椎体作为 C1-C2-C3 脱位合并 C2 后弓缺如的治疗中“关键结构”。
C2 Body as "Keystone" in Management of C1-C2-C3 Dislocation Secondary to Congenital Absence of C2 Posterior Elements.
机构信息
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
World Neurosurg. 2018 Feb;110:117-120. doi: 10.1016/j.wneu.2017.10.166. Epub 2017 Nov 10.
BACKGROUND
Congenital absence of C2 posterior arch may present with C2-C3 dislocation. Previously these cases were managed by fusing occiput-C1-C4 without including C2 in the construct. Such constructs are likely to immobilize the long segment of the cervical spine, and exclusion of C2 may not yield the best result.
CASE DESCRIPTION
We report a case with congenital absence of posterior arch of axis with C2-3 and C1-C2 dislocation who presented with progressive spastic quadriparesis. The inferior facets of C2 were rudimentary. In our patient the C1-C2-C3 dislocations were stabilized with C1 and C3 lateral mass along with C2 pedicle screws. Clinical improvement with radiologic realignment occurred.
CONCLUSION
Absence of the posterior arch of axis may be associated with adjacent C1-C2 along with C2-C3 dislocation, so both levels need to be addressed. The radiology should be critically evaluated for other structures developing from the C2 neural arch. It is important to include C2 to achieve a stable construct without compromising adjacent-level mobility.
背景
先天性 C2 后弓缺失可能表现为 C2-C3 脱位。以前，这些病例通过融合枕骨-C1-C4 来治疗，不包括 C2 在构建中。这样的构建可能会使颈椎的长节段固定，不包括 C2 可能不会产生最佳效果。
病例描述
我们报告了一例先天性枢椎后弓缺失伴 C2-3 和 C1-C2 脱位的病例，表现为进行性痉挛性四肢瘫痪。C2 的下关节突是原始的。在我们的患者中，C1-C2-C3 脱位通过 C1 和 C3 侧块以及 C2 椎弓根螺钉稳定。影像学矫正后出现临床改善。
结论
枢椎后弓缺失可能与相邻的 C1-C2 以及 C2-C3 脱位有关，因此需要处理这两个水平。应仔细评估 C2 神经弓发育的其他结构的影像学表现。为了实现稳定的构建而不影响相邻水平的活动度，将 C2 包括在内很重要。
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