Abstract:We found a direct relationship between spinal instability and the presence of neurologic deficit (P < 0.001). On the basis of this systematic review of case reports of lower cervical spondylolysis, we can recommend that spondylolysis of the lower cervical spine can be treated nonoperatively except in those with radiologically documented cervical instability.
“…For example, subaxial cervical spondylolysis is diagnosed far more often in adults, while C-2 spondylolysis is reported most often in children. In the subaxial spine, cervical spondylolysis is associated with instability in up to 30% of cases, 19,26 while in C-2 spondylolysis it occurs less frequently. A review of the literature reveals 22 reports of atraumatic C-2 spondylolysis, and we add 2 unique cases.…”
Cervical spondylolysis is an uncommon disorder involving a cleft at the pars interarticularis. It is most often found at the C-6 level, and clinical presentations have included incidental radiographic findings, neck pain, and rarely neurological compromise. Although subaxial cervical spondylolysis has been described in 150 patients, defects at the C-2 pedicles are rare. The authors present 2 new cases of C-2 spondylolysis in athletically active young persons who did not demonstrate instability or neurological deficits, were able to remain active, and are being managed conservatively with serial examinations and imaging. They also discuss the results of 22 previously reported cases of C-2 spondylolysis. Based on the literature and their own experience, the authors conclude that most patients with C-2 spondylolysis remain neurologically intact, maintain stability despite the bony defect, and can be managed conservatively. Surgery is reserved for patients who demonstrate severe instability or spinal cord compromise due to stenosis.
“…For example, subaxial cervical spondylolysis is diagnosed far more often in adults, while C-2 spondylolysis is reported most often in children. In the subaxial spine, cervical spondylolysis is associated with instability in up to 30% of cases, 19,26 while in C-2 spondylolysis it occurs less frequently. A review of the literature reveals 22 reports of atraumatic C-2 spondylolysis, and we add 2 unique cases.…”
Cervical spondylolysis is an uncommon disorder involving a cleft at the pars interarticularis. It is most often found at the C-6 level, and clinical presentations have included incidental radiographic findings, neck pain, and rarely neurological compromise. Although subaxial cervical spondylolysis has been described in 150 patients, defects at the C-2 pedicles are rare. The authors present 2 new cases of C-2 spondylolysis in athletically active young persons who did not demonstrate instability or neurological deficits, were able to remain active, and are being managed conservatively with serial examinations and imaging. They also discuss the results of 22 previously reported cases of C-2 spondylolysis. Based on the literature and their own experience, the authors conclude that most patients with C-2 spondylolysis remain neurologically intact, maintain stability despite the bony defect, and can be managed conservatively. Surgery is reserved for patients who demonstrate severe instability or spinal cord compromise due to stenosis.
“…The exact cause for cervical spondylolysis is still debatable. [1][2][3][4][5][6][7] Etiologies proposed include developmental causes, microtrauma, and posttraumatic nonunion with pseudoarthrosis. The cause of cervical spondylolysis is often considered congenital or developmental when in the presence of other congenital anomalies.…”
Section: Discussionmentioning
confidence: 99%
“…[1][2][3][4][5][6][7] It is primarily secondary to microtrauma, pseudarthrosis, and congenital conditions such as spondylolisthesis or spina bifida. [1][2][3][4][5][6][7] In this report, we present a rare case of bilateral cervical spondylolysis and atlantoaxial instability in the same individual.…”
Cervical spondylolysis is an uncommon condition, which can be associated with spondylolisthesis or spina bifida. In this report we described a case involving an individual with both bilateral cervical spondylolysis and atlantoaxial instability.
“…Cevical sagittal rotation (>20°) was considered unstable [ 14 ]. Figure 1 illustrates the lines and angles constructed by the computer in Method 1, Method 2 and Method 3 [ 15 – 17 ]. Figure 1 The illustration of the lines and angles in Method 1, Method 2 and Method 3. a Measurement of the angle from the inferior endplate of the vertebra above the degenerative disc to the superior endplate of the vertebra below on the flexion and extension films.…”
BackgroundDiagnosis and treatment decisions of cervical instability are made, in part, based on the clinician’s assessment of sagittal rotation on flexion and extension radiographs. The objective of this study is to evaluate the intraobserver and interobserver reliability of three measurement techniques in assessing cervical sagittal rotation.MethodsFifty lateral radiographs of patients with single-level cervical degenerative disc were selected and measured on two separate occasions by three spine surgeons using three different measurement techniques. Cervical sagittal rotation was measured using three different techniques.ResultsIntraclass correlation coefficients were most consistent for Method 2 (ICC 0.93-0.96) followed by Method 1 (ICC 0.88-0.91) and Method 3 (ICC 0.81-0.87). Intraobserver agreement (% of repeated measures within 0.5° of the original measurement) ranged between 76% and 96% for all techniques, with Method 2 showing the best agreement (92%-96%). Paired comparisons between observers varied considerably with interobserver reliability correlation coefficients ranging from 0.54 to 0.89. Method 2 showed the highest interobserver reliability coefficient (0.82, range 0.73-0.88). Method 2 was also more reliable for the classification of “instability”. Intraobserver percent agreements ranged from 94 to 98% for Method 2 versus 84% to 90% for Method 1 and 78% to 86% for Method 3, while interobserver percent agreements ranged from 90% to 98% for Method 2 versus 86% to 94% for Method 1 and 74% to 84% for Method 3.ConclusionsMethod 2 (measuring the angle from the inferior endplate of the vertebra above the degenerative disc and the inferior endplate of the vertebra below the degenerative disc) showed the best intraobserver and interobserver reliability overall in assessing cervical sagittal rotation.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-332) contains supplementary material, which is available to authorized users.
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