title: Cervical Fusion for Absent Pedicle Syndrome Manifesting with Myelopathy.
abstract: BACKGROUND
  Absent congenital pedicle syndrome is a posterior arch defect characterized by numerous congenital and mechanical abnormalities that result from disconnection of the anterior and posterior columns of the spinal canal. Absent congenital pedicle syndrome is a rare anomaly that is most commonly diagnosed incidentally, after evaluation of minor trauma, or after complaints of chronic neck pain. We report a case of absent congenital pedicle syndrome in a patient who presented with myelopathy and lower extremity weakness and review the literature on the surgical management of this entity.
  
  
  METHODS
  A 32-year-old woman with a history of systemic lupus erythematosus presented to the Neurosurgery Service with progressive weakness in her upper and lower extremities, clonus, and hyperreflexia. Magnetic resonance imaging revealed congenital absence of the pedicles of C2, C3, C4, C5, and C6 with a congenitally narrow canal at C4-5. The patient underwent a staged anterior and posterior cervical decompression and fusion. She was placed in a halo after surgery; at the 1-year follow-up, she was ambulatory with demonstrated improvement in weakness and fusion of her cervical spine.
  
  
  CONCLUSIONS
  Absent congenital pedicle syndrome is rare, and most reported cases were treated conservatively. Surgical management is reserved for patients with myelopathy or instability.
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: C Rory
authors.initials: CR
authors.lastname: Goodwin
authors.affiliation: Department of Neurosurgery, Stanford University, Stanford, California, USA.
authors.forename: Atman
authors.initials: A
authors.lastname: Desai
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Mohamed H
authors.initials: MH
authors.lastname: Khattab
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Elder
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Bydon
authors.affiliation: Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland, USA. Electronic address: jwolins2@jhmi.edu.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000002:abnormalities* / Q000601:surgery*; D005260:Female; D006801:Humans; D013117:Spinal Cord Compression / Q000175:diagnosis* / Q000209:etiology* / Q000601:surgery; D013123:Spinal Fusion
keywords: Absent pedicle syndrome; Cervical fusion; Congenital spondylosis; Myelopathy; Posterior arch defect; Spine; Surgery