Choy Wen Jie, Shivapathasundram Ganeshwaran, Cassar Lachlan, Mobbs Ralph J
NeuroSpine Surgery Research Group (NSURG), Sydney, Australia.
Neurospine Clinic, Prince of Wales Private Hospital, Sydney, Australia.
J Surg Case Rep. 2020 Mar 2;2020(3):rjaa019. doi: 10.1093/jscr/rjaa019. eCollection 2020 Mar.
The atlas (C1) and axis (C2) have distinct morphologies to support the skull and facilitate head rotation and neck flexion. Congenital defects of C1 posterior arch are rare. We present a case of a 59-year-old man with both an absent C1 posterior arch with concomitant os odontoideum. The patient presented with neck crepitus, moderate neck pain and progressive worsening upper limbs paraesthesia and pain. Computed tomography (CT) revealed non-union between the odontoid process and body of axis as well as absence of C1 posterior arch. An occiput C0-C3 fusion was performed. The patient's symptoms improved significantly, and he is functioning well at 12 months. CT showed solid fusion without implant migration. Concomitant os odontoideum with aplastic C1 posterior arch is rare with limited evidence to guide management. Posterior fixation and fusion may be a potential solution to prevent dynamic compression, thereby preventing further myelopathy and related complications.
寰椎（C1）和枢椎（C2）具有独特的形态，以支撑颅骨并促进头部旋转和颈部屈曲。C1后弓先天性缺陷较为罕见。我们报告一例59岁男性，其C1后弓缺如并伴有齿突骨。患者表现为颈部摩擦音、中度颈部疼痛以及上肢感觉异常和疼痛进行性加重。计算机断层扫描（CT）显示齿突与枢椎体之间不愈合以及C1后弓缺如。实施了枕骨C0 - C3融合术。患者症状明显改善，术后12个月功能良好。CT显示融合牢固，植入物无移位。伴有齿突骨的C1后弓发育不全罕见，指导治疗的证据有限。后路固定融合术可能是预防动态压迫、从而防止进一步脊髓病及相关并发症的一种潜在解决方案。
