Occipitocervical malformation with atlas duplication
Journal
Journal of Neurology, Neurosurgery and Psychiatry
Journal Volume
82
Journal Issue
10
Pages
1101-1102
Date Issued
2011
Author(s)
Abstract
A 55-year-old man presented to our institution with tetraparesis after a ground-level fall. The presence of hyper-reflexia in four limbs led to suspicion of cervical myelopathy. Initial cervical spine plain x-ray films showed spinal canal stenosis at C1/C2, os odontoideum and two atlas-like vertebrae. Duplication of the atlas in humans has never been reported before.1
Case presentation
A 55-year-old man with no significant medical history had a ground-level fall after consuming alcohol several months prior to the current clinical presentation. Unsteady gait developed thereafter. On neurological examination, he had symmetric and nearly full strength in his four limbs, but hyper-reflexia was noted in his four limbs. Bakinski and Hofmann signs were positive on both sides. Adduction of left fourth and fifth digits was weaker, 4/5. Ambulation showed spastic gait.
Dynamic views of plain x-ray studies showed two atlas-like vertebrae (figure 1, arrows) between the occipital bone and the axis without obvious instability. There are a total of eight levels of cervical vertebrae. CT showed two atlases (figure 2, arrow pointing to the left upper). There was an anterior arch defect of the second atlas (figure 2, the first horizontal arrow from the top). The os odontoideum was also identified by CT (figure 2, the second horizontal arrow from the top). 3D reconstruction images disclosed a more detailed view of the anatomical structures at the occipitocervical junction (figure 3). Posterior decompression with posterior fusion was performed. The patient was discharged within 1 week after the surgery, and he could ambulate independently.
SDGs
Other Subjects
adult; alcohol consumption; article; atlantooccipital joint; atlas; atlas duplication; bone malformation; case report; clinical feature; computer assisted tomography; decompression surgery; human; hyperreflexia; male; neurologic examination; odontoid process; outcome assessment; priority journal; spine disease; X ray; atlas; axis; computer assisted tomography; congenital malformation; falling; image processing; middle aged; occipital bone; odontoid process; pathological reflex; physiology; quadriplegia; radiography; spine fusion; three dimensional imaging; Accidental Falls; Axis; Cervical Atlas; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Male; Middle Aged; Neurologic Examination; Occipital Bone; Odontoid Process; Quadriplegia; Reflex, Abnormal; Spinal Fusion; Tomography, X-Ray Computed
Type
journal article