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Utilization of Cross Sectional Imaging to Accurately Diagnose of an Uncommon Benign Cervical Congenital Anomaly 2013

Category General Spine Jonathan Musco, ABR Board Certified
Erol Baskurt, ABR Board Certified, CAQ Neuroradiology
Purpose To demonstrate the utility of cross sectional imaging in a patient with abnormal findings on plain films after acute cervical trauma. To illustrate both the plain film and CT findings of a rare cervical congenital anomaly and demonstrate the importance of recognizing this congenital anomaly. Materials & Methods Congenital absence of the cervical pedicle was first described by Haley in 1946, since then fewer than 100 cases have been described worldwide. Congenitally absent cervical pedicle can be misinterpreted as a number of clinically significant conditions including neoplastic lytic lesion, neurofibroma, erosion from a tortuous vertebral artery, and acute osseous injury. Results A review of the literature shows that many of these lesions are found incidentally when a patient presents to the emergency department after acute trauma involving the cervical spine.  Plain radiography findings include enlarged ipsilateral articular neural foramen due to the absent pedicle, dorsally displaced ipsilateral articular pillar and lamina, and a dysplastic transverse process. Although these findings are well described in the literature and are most consistent with congenitally absent cervical pedicle, physical exam findings may be equivocal or concerning for acute injury and cross sectional imaging is often obtained to confirm the diagnosis and rule out other clinically significant etiologies such as a malignant lytic process and acute osseous and/or ligamentous injury. Computed tomography is often the next step in the imaging process and can confirm the diagnosis of a congenitally absent pedicle while also allowing for further evaluation of the cervical spine. 3-D reconstructed images can also be obtained and help to provide a comprehensive anatomic depiction of this uncommon finding. In the absence of additional findings these patients are often treated conservatively and discharged from the Emergency Department for follow up with their primary care providers. Conclusion Advanced cross sectional imaging plays an important role in confirming the diagnosis of a congenitally absent cervical pedicle and prevents additional and potentially harmful management of this benign yet uncommon finding. References
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