Baram Ali, Capo Gabriele, Brembilla Carlo, Ortolina Alessandro, Cracchiolo Giorgio, Riva Marco, Pessina Federico, Fornari Maurizio
Department of Neurosurgery, IRCCS Humanitas Research Hospital, Milan, Italy.
University of Milano-Bicocca, School of Medicine and Surgery, Bergamo, Italy.
J Neurosurg Case Lessons. 2024 Aug 26;8(9). doi: 10.3171/CASE24174.
Congenital cervical spondylolytic spondylolisthesis is a rare and complex disorder of the cervical spine. Surgical treatment is reserved for those symptomatic patients who do not improve with conservative management.
A 34-year-old man presented with bilateral C7 radiculopathy for the past 6 months. Magnetic resonance imaging of the cervical spine revealed grade II C6-7 spondylolisthesis. Computed tomography showed the presence of spondyloarthritis, bilateral pedicle dysplasia, bilateral isthmic defect, and spinous process schisis. Dynamic radiographs showed no signs of vertebral instability. Dynamic magnetic resonance imaging showed kinking of the spinal cord over the fulcrum of C6-7 kyphosis during flexion, with no signs of myelopathy. The patient underwent C6-7 anterior fusion surgery. His symptoms improved postoperatively, with a 2-month computed tomography scan showing initial bony bridging.
The absence of evident instability on radiography does not always correspond to the absence of actual functional compression of neurological structures. Spinal misalignment, muscle dysfunction, and kyphotic deformity with kinking of the spinal cord and stretching of the nerve roots may also contribute to the development of symptoms. In this setting, dynamic magnetic resonance imaging can be extremely useful. Single-level anterior fusion surgery without posterior fixation can achieve solid fusion and improve the clinical conditions of patients. https://thejns.org/doi/10.3171/CASE24174.
先天性颈椎峡部裂性脊椎滑脱是一种罕见且复杂的颈椎疾病。手术治疗适用于那些经保守治疗无改善的有症状患者。
一名34岁男性在过去6个月出现双侧C7神经根病。颈椎磁共振成像显示C6 - 7椎体II度滑脱。计算机断层扫描显示存在脊椎关节炎、双侧椎弓根发育异常、双侧峡部缺损和棘突裂。动态X线片未显示椎体不稳定迹象。动态磁共振成像显示在屈曲时脊髓在C6 - 7后凸的支点处扭结，无脊髓病迹象。该患者接受了C6 - 7前路融合手术。术后症状改善，术后2个月的计算机断层扫描显示初步骨桥形成。
X线片上无明显不稳定并不总是意味着神经结构不存在实际功能性压迫。脊柱排列不齐、肌肉功能障碍以及伴有脊髓扭结和神经根拉伸的后凸畸形也可能导致症状的出现。在这种情况下，动态磁共振成像可能非常有用。无需后路固定的单节段前路融合手术可实现牢固融合并改善患者的临床状况。https://thejns.org/doi/10.3171/CASE24174
