J Korean Soc Traumatol.  2013 Mar;26(1):30-33.

Congenital Defects of the Atlantal Arch Presenting Incidentally after Trauma

• Rhee ST

Abstract

A 55-year-old woman was seen in the emergency department with posterior neck pain and a headache after a traffic accident. Physical examination revealed tenderness on palpation over the posterior skull and a midline spinous process of the cervical spine without neurologic deficit. A plain radiograph of the cervical spine demonstrated the absence of the lateral portion of the posterior arch of the atlas and very lucent shadowing of the anterior midline of the atlas, suggesting a fracture of the anterior arch. On three-dimensional computed tomography (CT) of the cervical spine, anterior and posterior bony defects of the atlas were noted. Well-corticated defects were noted with sclerotic change and with no evidence of soft tissue swelling adjacent to the bony discontinuities, consistent with a congenital abnormality. With conservative therapy, the patient gradually showed a lessening of the midline tenderness. Careful investigation with radiography or CT is needed for these patients to avoid confusion with a fracture, because these patients seldom need surgical treatment.

Keyword

Atlas; Neurologic deficit; Congenital abnormality; Computed tomography

MeSH Terms

Accidents, Traffic
Congenital Abnormalities
Emergencies
Female
Headache
Humans
Neck Pain
Neurologic Manifestations
Palpation
Physical Examination
Shadowing (Histology)
Skull
Spine