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. 2008;31(1):83-7.
doi: 10.1080/10790268.2008.11753986.

Acute cervical fracture or congenital spinal deformity?

James S Harrop  1 , Shiveindra Jeyamohan, Ashwini Sharan, John Ratliff, Adam Flanders, Mitchell Maltenfort, Stephen Falowski, Alexander Vaccaro
Affiliations

Acute cervical fracture or congenital spinal deformity?

James S Harrop et al. J Spinal Cord Med. 2008.

Abstract

Background/objective: There are few reports of developmental or congenital cervical spinal deformities. Such cases may be mistaken for traumatically induced fractures, and additional treatment may ensue.

Methods: A retrospective analysis was performed to identify patients with congenital cervical spine deformities. These patients were matched with a confirmed traumatic spinal fracture population with similar demographic features. Patients were analyzed for age, gender, imaging findings (plain roentgenograms including dynamic flexion and extension views, computed tomography scan, and MRI), neurologic status, and subjective complaints of pain.

Results: Thirty-six individuals were included in the final analysis, 7 with congenital abnormalities and 29 with radiographically confirmed traumatic injuries. Patients with congenital abnormalities had significantly less soft-tissue swelling compared with the population with traumatic fractures (P < 0.001). Furthermore, those with congenital defects presented with lesser degrees of vertebral subluxation (0.29 mm vs 7.24 mm) (P < 0.0001) and without neurologic deficits (P < 0.0001).

Conclusions: Congenital abnormalities, though rare, can be mistaken for traumatic fractures of the spine. Physicians should note any evidence of soft-tissue swelling, neurologic deficits, degree of subluxation, and radiographic evidence of pedicle absence because these characteristics often provide insight into the specific etiology of the observed spinal deformity (congenital vs traumatic).

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Figures

Figure 1
Figure 1. Lateral cervical spine radiograph. Patient was transferred for evaluation from an outside hospital after a minor motor vehicle crash, and the question of a C3 fracture. Note: the smooth borders, the absence of the C3 pedicle, and abnormal C3–C4 facet complex (arrow).
Figure 3
Figure 3. Axial computed tomography scan through C4 vertebral body illustrating the absence of the pedicle. Note the well-corticated margins (arrows).
Figure 2
Figure 2. Reformatted computed tomography scan of the cervical spine of the facet joints: (A) right side, (B) left side.
See this image and copyright information in PMC

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