Diagnosis
Bilateral spondylolysis of the sixth cervical
vertebra.</<span class="end-tag" />
Findings
The lateral radiograph of the cervical spine showed the presence of
a defect of the pars interarticularis at C6. Grade-1 (&
lt;25%) spondylolisthesis of C6 anteriorly
with respect to C7 was also noted on the lateral view. There was no
increase in the prevertebral soft tissue density anterior to C6.
Flexion and extension views did not reveal instability of the
cervical spine (Figure 1). Additionally, spina bi&
#64257;da occulta was observed on the
anteroposterior view (Figure 2). </<span class="end-tag"
/>P
><
P
>Axial noncontrast CT at the C6 level showed bilateral
well-corticated defects of the pars interarticularis. It also
con&
#64257;rmed the presence of
spina bi&
#64257;da occulta and
medial displacement of the laminae. Again, soft tissue swelling
indicative of acute trauma was not detected (Figure 3).
</<span class="end-tag" />P
Discussion
Spondylolysis with spondylolisthesis is a common condition in the
lumbar spine. Cervical spondylolysis is, however, much more rare
than its lumbar counterpart and is described as a well-corticated
cleft between the superior and inferior articular facets of the
articular pillar of the cervical spine.<
Sup>1,2 </<span class="end-tag"
/>Sup></<span class="end-tag" />P
><
P
>It is usually discovered as an incidental radiologic
&
#64257;nding in patients who are
undergoing cervical spine imaging for neck pain or trauma<
Sup>2,3 </<span class="end-tag"
/>Sup>Associated neurological de&
#64257;cit may be detected, although spinal
cord compression is rare.<
Sup>4 </<span class="end-tag"
/>Sup>This condition mostly affects the sixth cervical
vertebra, although involvement of other cervical vertebrae has been
reported.<
Sup>5 </<span
class="end-tag" />Sup></<span class="end-tag"
/>P
><
P
>Plain-&
#64257;lm
radiography and CT are the principal diagnostic modalities that
help in differentiating cervical spondylolysis from articular
pillar fracture or dislocation. In addition to the distinctive pars
interarticularis defect, other imaging &
#64257;ndings described in cervical
spondylolysis are hyposplasia of the pedicles, dysplastic laminae,
and spina bi&
#64257;da. Medial
displacement of inferior facets and laminae, compensatory
hypertrophic changes of the articular process in the adjacent
vertebrae, and spondylolisthesis are also seen.<
Sup>2,6,7 </<span class="end-tag"
/>Sup>The pars interarticularis defect is dif&
#64257;cult to identify on magnetic resonance
imaging because of poor bone resolution; however, the absence of
the spinous process on sagittal sequences should raise the
suspicion of this abnormality.<
Sup>2,8 </<span class="end-tag"
/>Sup></<span class="end-tag" />P
><
P
>The exact etiology of cervical spondylolysis remains
unknown. The detection of articular dysplasia and spina
bi&
#64257;da occulta on imaging
studies suggests a congenital origin of this condition. A dysplasia
mechanism with stress fractures of a weakened pars interarticularis
is another possibility.<
Sup>3
</<span class="end-tag" />Sup>Patient management is
usually conservative, with surgical treatment reserved for patients
with a neurologic de&
#64257;cit.<
Sup>1,2 </<span class="end-tag"
/>Sup></<span class="end-tag" />P
><
p><
B>CONCLUSION </<span
class="end-tag" />B></<span class="end-tag"
/>p><
P
>Cervical spondylolysis is a rare condition. It is
usually discovered incidentally and should be differentiated from
traumatic spondylolysis. Plain-&
#64257;lm radiography and CT are the main
diagnostic imaging modalities.
<
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#64257;ndings in 12 patients. AJR Am J
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><
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>Fessy MH, Durand JM, Gunepin FX, et al. An unusual
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>Jeyapalan K, Chavda SV. Case report 868. Congenital
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of C6. Radiology. 2001;220:191-194. </<span class="end-tag"
/>LI
><
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>Redla S, Sikdar T, Saifuddin A, Taylor BA. Imaging
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mdash;with emphasis on MR appearances. Clin
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></<span class="end-tag" />OL
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