Evaluation and treatment of congenital and developmental anomalies of the cervical spine. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004.
Congenital and developmental osseous abnormalities of the cervical spine can result in neural compression ranging from the medulla oblongata to the cervicothoracic spinal cord junction. These may present in infancy as scoliosis and even limb weakness. A high index of suspicion is essential. Neurodiagnostic imaging relies on high-resolution computerized tomography (CT) scanning and three-dimensional CT reconstructions as well as magnetic resonance imaging and angiography. The anatomical/physiological CT factors considered when developing a surgical approach are: 1) the stability and reducibility of the lesions; 2) direction and manner of encroachment of the lesion on the neural structures; 3) neural and vascular abnormalities; and 4) growth potential of the affected area. Primary stabilization is required for reducible lesions, whereas irreducible lesions are decompressed in the manner in which encroachment has occurred. Instability, whether present before or after operative intervention, required spinal stabilization. Illustrative examples of this approach are presented.
Menezes
Arnold H
AH
Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA. arnold-menezes@uiowa.edu
D000293:Adolescent; D002574:Cervical Vertebrae / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D019299:Decompression, Surgical; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D007593:Joint Instability / Q000601:surgery; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D013117:Spinal Cord Compression / Q000209:etiology; D013121:Spinal Curvatures / Q000175:diagnosis / Q000601:surgery; D013122:Spinal Diseases / Q000151:congenital* / Q000601:surgery; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000473:pathology; D014057:Tomography, X-Ray Computed / Q000379:methods