title: Progressively unstable c2 spondylolysis requiring spinal fusion: case report.
abstract: Cervical spondylolysis is a rare condition defined as a corticated cleft at the pars interarticularis in the cervical spine. This is the case of C2 spondylolysis demonstrating progressive significant instability, which was successfully treated by anterior cervical discectomy and fusion (ACDF) with cervical anterior plate. We describe a 20-year-old female with C2 spondylolysis presenting with progressive worsening of neck pain associated with progressive instability at the C2/3 segment. The progression of instability was well-documented on flexion-extension cervical spine x-rays. She was successfully treated by C2/3 ACDF with anterior cervical plate. Her preoperative significant neck pain resolved immediately after the surgical intervention. She was completely free from neurological symptoms at 1-year postoperative follow-up. We also review the literature and discuss 24 reported cases with C2 spondylolysis. When planning treatment, we should make sure to differentiate this pathology from acute traumatic fracture, which is a hangman's fracture. Assessment of C2/3 instability associated with neurological deficits is extremely important to consider management properly. C2/3 ACDF with cervical plate is biomechanically viable, less invasive, and provides adequate surgical stabilization for unstable C2 spondylolysis.
authors.affiliation: Division of Neurosurgery, St. Michael's Hospital, University of Toronto.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nishimura
authors.forename: Michael John
authors.initials: MJ
authors.lastname: Ellis
authors.forename: Jennifer
authors.initials: J
authors.lastname: Anderson
authors.forename: Masahito
authors.initials: M
authors.lastname: Hara
authors.forename: Atsushi
authors.initials: A
authors.lastname: Natsume
authors.forename: Howard Joeseph
authors.initials: HJ
authors.lastname: Ginsberg
mesh_terms: D001860:Bone Plates; D002574:Cervical Vertebrae / Q000473:pathology* / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013169:Spondylolysis / Q000175:diagnosis* / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D055815:Young Adult