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BMC Medical Imaging 2010
Absent cervical spine pedicle and associated congenital spinal abnormalities - a diagnostic trap in a setting of acute trauma: case reportAbstract: This patient presented at the emergency unit of our university hospital after a motor vehicle accident and was sent to our radiology department for imaging of the cervical spine. Initial clinical examination and plain radiographs of the cervical spine were performed but not conclusive. Additional CT of the neck helped establish the right diagnosis.CT as a three-dimensional imaging modality with the possibility of multiplanar reconstructions allows for the exact diagnosis and exclusion of acute traumatic lesions of the cervical spine, especially in cases of doubtful plain radiographs and when congenital spinal abnormalities like absent cervical spine pedicle with associated spina bifida may insinuate severe trauma.Absent cervical spine pedicle (ACSP) is a very rare congenital abnormality of the spine. It has been described first in 1946 by Hadley [1-4] and is characterized by the absence of a pedicle of the affected vertebral body. ACSP may be associated with other congenital osseous abnormalities of the cervical spine [2,5,6]. Since most patients are asymptomatic for many years, the majority of them remain undiagnosed until neck injury, pain or paresthesias in the neck or arm warrant an imaging evaluation. In a setting of acute trauma however, ACSP can be a source of radiologic misdiagnosis i.e. on plain radiographs.Following a motor vehicle accident, a 38 year-old male patient presented at the emergency room of our hospital. He was alert and in stable condition with a GCS-score of 15. On clinical examination the patient showed mild neck tenderness to palpation as well as a slightly restricted range of motion. No sensomotor deficits of the neck or arms were present. The patient commented that he had been suffering from similar neck pain for many years prior to the accident.According to Canadian C-Spine rules and due to the mechanism of the accident radiography of the cervical spine was indicated. Antero-posterior and lateral radiographs as well as 45° oblique views
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