C3-C7 Anomalies Flashcards
What are other names for congenital fusion?
- congenital block vertebra
- congenital synostosis
- non-segmentation defect
What is the technically correct term for congenital fusion?
Non-segmentation defect
(bc it occurs in utero; never had 2 segments bc 2 somites never separated)
Vertebral bodies arise from what embryonic structure?
Notochord
Congenital fusion occurs due to failure of ____
Somite segmentation
Congenital fusion most commonly affects how many segments?
2
What spinal levels are most commonly affected by Congenital fusion?
C5/6
C2/3
T12/L1
When a Congenital fusion involves 2 or more segments, what should you consider?
Klippel Feil syndrome
What are the radiographic findings of a Congenital fusion?
- hypoplastic disc
- wasp waist deformity
- 50% of cases involve fusion of facets (but all cases have fusion of bodies)
What spinal level cannot have a Congenital fusion?
C1-C2 (no disc here)
What is the clinical significance of a Congenital fusion?
Concern for biomechanical instability immediately above or below the fusion
What is your next step if you find a Congenital fusion?
Need flexion/extension radiographs to check for instability
(May have step-off deformity above or below fusion)
What is the diagnosis? How can you tell?
Surgical fusion:
- no loss of A-P dimension (wasp waist)
- no hypoplastic disc (usually scooped out & packed with bone chips)
(Other possibilities, not visualized)
- may involve C1-C2
- may involve posterior elements ONLY
- may have surgical hardware
What is the most common method of surgical fusion?
ACDF (anterior c-spine discectomy & fusion)
= scoop out disc, pack spacers with bone chips, hold in place with titanium
If you find out a patient has a surgical fusion, what are your next steps?
Flexion/extension radiographs to check for instability above & below the fusion
In a patient with a surgical fusion, what are your 2 concerns?
- instability above/below
- did the fusion take?
What is the diagnostic criteria for Klippel Feil syndrome?
Multiple Congenital block vertebrae in the cervical spine
In a patient with Klippel Feil syndrome, what are your concerns?
- hypermobility/instability issues
- neurologic concerns
- associated cardiac & renal anomalies
What are your next steps for a patient who has Klippel Feil syndrome?
- flexion/extension radiographs
- thorough neuro exam
- refer to cardiology & urology
What other diagnoses are frequently associated with Klippel Feil syndrome?
- Omovertebral bone
- Sprengel deformity
What is an omovertebral bone?
Bone connecting scapula to spine
What is a Sprengel deformity?
Failure of scapula to descend during development, resulting in short, webbed neck and decreased ROM
Give 2 findings seen at C5/C6.
- wasp waist deformity
- hypoplastic disc
(Congenital fusion)
Give 2 findings seen at C5/C6.
- wasp waist deformity
- hypoplastic disc
(Congenital fusion)
What is the diagnosis?
Surgical fusion
What is the diagnosis?
Klippel Feil syndrome
Name 2 additional diagnoses
- Sprengel deformity
- omovertebral bone
What is a cervical spondylolisthesis?
Antero/retrolisthesis of cervical vertebrae relative to the segment below
What is the most common location of a cervical rib?
C7
What are the types/forms of cervical ribs?
partial or complete
(may be unilateral or bilateral)
What is the clinical presentation of cervical ribs?
- mostly asymptomatic
- may cause TOS (40s-50s pt)
What orthopedic test(s) should be performed if a patient is complaining of upper extremity numbness/pain/weakness?
- Adson’s
- ROOS
- Cervical compression
(for TOS DDx)
How can you tell a cervical rib from a thoracic TP radiographically?
cervical ribs point down, thoracic TPs point up
What is the clinical significance of an elongated TP? What are your next steps for this patient?
- soft tissue implications:
may change path of scalenes/brachial plexus - If symptomatic, brachial plexus MRI. Otherwise myofascial release of scalenes, adjust CT & ribs
How is a cervical rib differentiated from an elongated TP radiographically?
No extra bone/joint seen with elongated TP, continuous with vertebra
What is the diagnosis?
Cervical rib
What is the diagnosis?
Elongated cervical TP
