Adult cervical spondylolysis: a case report

초록

We report a case of spondylolysis with an exceptional involvement of the cervical spine, and its management. Spondylolysis is turned out to be a defect in the pars interarticularis of a cervical vertebra, and is a common clinical entity in the lumbar spine (5% of the population), however, it rarely occurs in the cervical spine, and congenital one occurs predominantly at the C6 level. The differential diagnosis include congenital absence of a cervical pedicle and trauma. Congenital articular dysplasia is always found, but is not a pathognomonic sign of congenital condition rather than secondary to stress fractures.A 20-year-old woman was referred with the diagnosis of unstable bipedicular fracture of C6. 2 years aog, she presented neck pain and both shoulder tingling sensation after minor trauma. There was no spinal cord syndrome. The standard x-rays and CT suggested a congenital or acquired anomaly with lysis of the pars interarticularis, spondylolisthesis, and spina bifida occulta at C6Anterior interbody fusion C6-7 with Atlantis plate with iliac bone graft performed and the patient was symptom free after surgery. Cervical spondylolysis is an exceptional anomaly. Diagnosis can be suspected on standard x-ray and is confirmed with CT. Congenital articular dysplasia is always found, but no argument has been put forward which would confirm that spondylolysis is itself a congenital rather than acquired stres lesion. The vast majority of patients can be treated with conservative measures.In early stages, complete healing can be achieved by conservative treatment (abstinence from sports activities for 3 months, orthesis). The limits of exercise tolerance vary among the patientses and require the decision of the physician. Surgical intervention should be reserved for those who fail nonoperative management or who exhibit neurologic compromise. Persistence of pain, neurologic symptoms and progression of vertebral slipping are indications for operative treatment.