Aslam Sarmad, Aslam Iqrah, Tsang Jeffrey, Latief Farris, Thatuskar Adarsh, Rojed Naveen
Department of Radiology, Lincoln County Hospital, Lincoln, UK.
King's College London School of Medicine, London, UK.
BJR Case Rep. 2022 Nov 1;8(6):20210119. doi: 10.1259/bjrcr.20210119.
There are several anatomical variants of the cervical vertebrae described in literature ranging from benign findings to those with varying clinical implications, including association with congenital diseases. We describe a case of an extremely rare anatomical variant of the cervical spine consisting of an accessory articulation of the cervical vertebrae C4 and C5 right transverse processes. The case is of a 35-year-old female who presented to primary care with 6-week history of intermittent, dull neck pain. An X-ray of the cervical spine was obtained which did not demonstrate radiological evidence of an acute fracture, dislocation, nor vertebral collapse. However, the X-ray revealed subtle multilevel anterior marginal osteophytic lipping. As a minor fragmented fracture or osteophytic growth could not be excluded; the patient proceeded to have a CT of the cervical spine. This revealed an accessory articulation of both the C4 and C5 right transverse processes, an extremely rare anatomical variant. Our comparison of both X-ray and CT imaging modality results highlighted the importance of utilising CT in identification in the accessory articulation anomaly, which aids in directing patient to appropriate care. Although similar cases may have been seen in clinical practice, to our knowledge, there are no previously documented C4-5 accessory articulations in the literature.
文献中描述了颈椎的几种解剖变异，从良性表现到具有不同临床意义的变异，包括与先天性疾病的关联。我们描述了一例极其罕见的颈椎解剖变异病例，该变异为颈椎C4和C5右侧横突的副关节。该病例为一名35岁女性，因间歇性钝性颈部疼痛6周就诊于初级保健机构。进行了颈椎X线检查，未显示急性骨折、脱位或椎体塌陷的影像学证据。然而，X线显示有细微的多节段前缘骨赘形成。由于不能排除轻微的粉碎性骨折或骨赘生长；患者随后进行了颈椎CT检查。结果显示C4和C5右侧横突均有副关节，这是一种极其罕见的解剖变异。我们对X线和CT成像方式结果的比较突出了利用CT识别副关节异常的重要性，这有助于指导患者接受适当的治疗。尽管在临床实践中可能见过类似病例，但据我们所知，文献中此前没有C4-5副关节的记录。
