High cervical C3-4 'disc' compression associated with basilar invagination.
A 20-year-old male had torticollis and short neck since birth. He presented with symptom of progressive quadriparesis over a two-year period. Investigations revealed basilar invagination with marked rotation in the craniovertebral region and relatively large C3-4 region osteophytes. Serial MRI over two years showed persistent signal opposite C3-4 disc space suggestive of cord compression. Although the cord was humped over the odontoid process, there was no clear radiological evidence that the cord was compromised at this level. During surgery, instability was identified only at the craniovertebral region and not at the level of C3-4. Distraction of the lateral masses of atlas and axis and fixation using interarticular spacers and bone graft and direct screw implantation in the lateral mass of the atlas and pars of the axis resulted in reduction of the basilar invagination and of atlantoaxial dislocation. The patient had marked clinical recovery, despite the fact that no direct procedure was done for C3-4 disc decompression. The case suggests that C3-4 disc changes could be secondary to primary instability at the craniovertebral junction.
Goel
Atul
A
Department of Neurosurgery, King Edward Memorial Hospital and Seth G.S. Medical College, Parel, Mumbai, India. atulgoel62@hotmail.com
D001268:Atlanto-Axial Joint / Q000601:surgery; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000473:pathology*; D019299:Decompression, Surgical / Q000379:methods*; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009809:Odontoid Process; D010985:Platybasia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult