68 C2 over C3 Spondyloptosis in a Case with Absent Posterior Elements of Axis

68

C2 over C3 Spondyloptosis in a Case with Absent Posterior Elements of Axis

ATUL GOEL AND DATTATRAYA P. MUZUMDAR

Diagnosis C2 over C3 spondyloptosis in a case with absent posterior elements of axis

Problem and Tactics An extremely rare anomaly in a 31-year-old man where the posterior elements of axis were almost completely absent, and the anterior elements were dislocated anterior to the body of the C3 vertebra. The body of the C3 caused severe compression of the high cervical cord. A radical transoral decompression and plate and screw fixation resulted in sustained clinical improvement. The literature is briefly reviewed and the treatment options in such a case are analyzed.

Keywords Axis, craniovertebral anomaly, spinal dislocation, spondyloptosis

Clinical Presentation

A 31-year-old man presented with progressively worsening stiffness and weakness in all limbs for 1 year. For 1 month the disability worsened rapidly and he needed support to walk or stand, and he could not perform his routine activities normally. In addition, for 1 month he developed tingling paresthesia in all four limbs. There were no urine or bowel problems. There was no history of any trauma. His neck was relatively short since birth. Neurological examination revealed spastic Grade 4 quadriparesis, deep tendon jerks were exaggerated, and the planters were extensors. The rest of the neurological examination was normal including the lower cranial nerves and the sensory system examination. Cervical movements were unrestricted. Plain radiography, magnetic resonance imaging, and computed tomography (CT) scan of the craniovertebral junction in flexion and extension revealed complete absence of all the posterior elements of the axis vertebra by way of transverse processes, lateral masses, laminae, and spinous process (Figs. 68–1, 68–2, and 68–3). The body of the axis was dislocated anterior to the C3 body in a form of almost complete spondyloptosis. Large bony osteophytes were seen anterior to the body of C2 and C4 vertebrae. The body of the C3 vertebra severely compressed the adjacent cervical cord. There was no evidence of instability on dynamic films. There was no anomaly of the odontoid process or any other bone in the region.

Surgical Technique

The patient was placed in traction, which had to be instantly removed because the patient complained of diplopia and exaggerated paresthesiae in the limbs.

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