J Korean Orthop Assoc.  2007 Aug;42(4):559-564. 10.4055/jkoa.2007.42.4.559.

Coincidental Congenital Absence of the Posterior Arch of the Atlas and the Unilateral Lumbosacral Articular Process: A Case Report

• Jeon CH
• Chung GY
• Chung NS
• Jeoung US
• Lee DH
• Jo JH

• KMID: 2186521
• DOI: http://doi.org/10.4055/jkoa.2007.42.4.559

Abstract

We encountered a case of coincidental congenital complete absence of the posterior arch of the atlas and the unilateral lumbosacral articular process. A 21-year-old man presented with pain in the lower back and right buttock. The patient was a swimming coach. On plain radiography, computerized tomography and magnetic resonance imaging, the congenital absence of the unilateral lumbosacral articular process was noted. Six months later, the patient developed severe neck pain and suboccipital headaches without neurological signs. On plain radiography and computerized tomography, the congenital complete absence of the posterior arch of the atlas was noted. Magnetic resonance imaging showed no abnormal signs originating from the posterior spinal cord. There was no segmental instability. For this case, the lower back pain and neck pain were managed by conservative treatment. To the best of our knowledge, this is the first case of a coincidental congenital complete absence of the posterior arch of the atlas and the unilateral lumbosacral articular process.

Keyword

Congenital anomaly; Articular process; Lumbar spine; Atlas; Posterior arch

MeSH Terms

Buttocks
Headache
Humans
Low Back Pain
Magnetic Resonance Imaging
Neck Pain
Radiography
Spinal Cord
Swimming
Young Adult

Figure

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  Fig. 1 On plain radiography, there was no segmental instability.

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  Fig. 2 A CT scan shows the absence of the unilateral lumbosacral apophyseal joint on the left side.

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  Fig. 3 MRI images show the absence of the unilateral lumbosacral apophyseal joint.

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  Fig. 4 The complete absence of the posterior arch of the atlas is present on a lateral plain x-ray.

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  Fig. 5 An axial CT scan identifies the complete absence of the posterior arch of the atlas.

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  Fig. 6 A dynamic view of the cervical spine during extension and flexion shows no atlantoaxial instability.

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  Fig. 7 A T1-weighted sagittal MRI image shows the absence of the posterior arch of the atlas.

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