- Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
Pars Advanced and Minimally Invasive Medical Manners Research Center, Pars Hospital, Iran University of Medical Sciences, Tehran, Iran
DOI:10.25259/SNI-92-2019Copyright: © 2019 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Abolfazl Rahimizadeh, Naser Asgari, Walter L. Williamson, Shaghayegh Rahimizadeh. Congenital cervical isthmic spondylolisthesis: A case report. 24-Apr-2019;10:57
How to cite this URL: Abolfazl Rahimizadeh, Naser Asgari, Walter L. Williamson, Shaghayegh Rahimizadeh. Congenital cervical isthmic spondylolisthesis: A case report. 24-Apr-2019;10:57. Available from: http://surgicalneurologyint.com/surgicalint-articles/9296/
Background:There are only 20 reported cases of cervical isthmic spondylolisthesis in literature that have been surgically managed either anteriorly or posteriorly. Herein, we report such a case managed with circumferential fusion.
Case Description:A 27-year-old male became progressively quadriparetic due to cervical isthmic spondylolisthesis at the C6–C7 level. Removal of the posterior arch of C6 with subsequent C5–C7 pedicle screw/rod fixation and anterior interbody fusion resulted in marked recovery and adequate cervical realignment.
Conclusion:For patients with cervical isthmic spondylolisthesis, circumferential fusion provides the best surgical option to achieve stability and sagittal balance.
Keywords: Cervical isthmic spondylolisthesis, cervical pedicle screw, cervical sagittal balance, cervical spine, circumferential fusion, 360 Spinal fixation
Spondylolysis of the subaxial cervical spine is uncommon, being reported in only 5% of the population.[
Bilateral subaxial cervical spondylolysis resulting in spondylolisthesis was first described by Perlman and Hawes since <20 cases have been reported.[
Herein, we present a patient with cervical isthmic spondylolisthesis at the C6 level and slippage on C7 vertebra. Removal of the loose arch followed by circumferential stabilization results in marked recovery.
A 27-year-old male was presented with 1 year of neck pain, dysesthesias in both hands, and difficulty walking. His neurological examination only showed hyperreflexia with Babinski signs.
The cervical lateral radiograph showed a 2-mm anterolisthesis at C6–C7, with bilateral defects at the pedicle-laminar junction of C6 vertebra. Furthermore, the spinous process of the C6 vertebra was abnormally long and narrow [
The axial computerized tomography (CT) showed a linear defect at the C6 pedicle-laminar junction bilaterally with sclerosis, Grade I spondylolisthesis, and an abnormally long C6 spinal process [
(a) The axial computed tomography (CT) scan on bone window settings reveals defect at the joints vertebral body with well-defined border, (b) sagittal reconstruction CT shows slippage of C6 on C7 and abnormally narrow and elongated spinal process of C6 vertebra are demonstrated, (c) paramedian slices show intrusion of spinolaminar junction into the spinal canal at C6 level, (d) in a more lateral sagittal slices, wide foramen which is combination of two foramina are demonstrated.
(a) T1-weighted sagittal view shows an isointense wrap around the theca which is probably fibrous. (b) T2-weighted sagittal magnetic resonance imaging (MRI) demonstrates myelomalacia at C6 level. (c) A more lateral T2-weighted sagittal MRI a block at C6 level is seen. (d) MR myelogram shows complete block between C6 and C7 levels.
The patient first underwent a posterior decompression (C6 posterior arch) with C5–C7 pedicle screw fusion [
Cervical spondylolysis is a relatively rare congenital anomaly which might be unilateral or bilateral and typically involves the lower cervical spine.[
Plain lateral radiograph document the spondylolisthesis often accompanied by bilateral hypoplasia of the pedicles, spina bifida, and elongation of the spinal processes. Oblique images may also demonstrate asymmetrical enlargement of the corresponding neural foramina.
CT studies clearly confirm the bilateral vertebral body-pedicle junction defects resulting in anterior anterolisthesis. The articular mass-vertebral body junction defects are clearly seen on these studies along with dysplasia of the posterior neural arches and elongation/deformed spinous processes.
The extent/severity of cord affection is best shown on the cervical T2-weighted sagittal MR images.[
In the ideal treatment of symptomatic cervical spondylolisthesis is circumferential fusion. This typically requires posterior decompression with pedicle screw-rod fixation followed by ACDF.
Cervical spondylolisthesis is rare and is best managed with circumferential fusion utilizing posterior decompression pedicle screw fixation followed by ACDF.
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The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
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Conflicts of interest
There are no conflicts of interest.
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