Cervical Spondylolysis in Child with Four Levels of Simultaneous Involvement: A Case Report

Abstract

Cervical spondylolysis is a rare condition, and fewer than 100 cases have been reported in the English literature since Perlman and Hawes first described the condition in 1951 (1). Cervical spondylolysis is a bilateral defect in the posterior element of a cervical vertebra, and is condition usually diagnosed in patients after minor trauma or as an incidental finding on routine radiographs. However, the etiology of cervical spondylolysis is unknown. We report a case of cervical spondylolysis involving four levels in a child, and include radiographs and CT images. Case ReportA 9-year-old boy visited to our hospital complaining of posterior neck pain of two days duration. The physical examination of the cervical spine conducted at the time, was unremarkable.However, a plain lateral radiographic view of the cervical spine revealed radiolucent defects in the pedicleneural arch regions at C2 (Fig. 1A), representing spondylolysis. Additionally, 2-mm of anterolisthesis of the C2 vertebral body upon C3 was observed, but there was no evidence of hypermobility or instability of the cervical spine. Associated spina bifida occulta was also observed to involve the C5, C6 and C7 levels (Fig. 1B).Computerized tomography (CT, Somatom Sensation 16, Siemens, Erlangen, Germany) demonstrated bilateral neural arch defects at the C2, C6 and C7 levels, with a unilateral defect at the C5 level on the left (Fig. 2 & 3). In addition, spina bifida occulta and dysplastic changes were evident at three abnormal cervical levels (C5-C7).The patient was treated conservatively, and no manipulation was performed over the levels affected by spondylolysis. The presenting clinical symptom resolved spontaneously. DiscussionCervical spondylolysis is defined as a corticated cleft Cervical spondylolysis is a rare condition, and less than 100 cases have been reported in the world literature. Cervical spondylolysis is defined as a well corticated defect in the posterior element of a cervical vertebra. Although the etiology of cervical spondylolysis is unknown, its association with dysplastic changes and spina bifida occulta suggest that the lesion is congenital. Here, we describe the radiographs and CT images of cervical spondylolysis involving four levels in a 9 year old boy.