Age / Sex : 19 / M

Chief complaint: neck pain, In-car TA (2weeks ago)

1) What is your impression?

Two weeks later, you can see the final diagnosis with a brief discussion of this case.

(Quiz는 quiz일 뿐이오니 답안은 한 개만 보내주시기 바랍니다)

Courtesy: 이상훈(Sang Hoon Lee), 서울아산병원(Asan Medical Center)

cervical Isthmic spondylolisthesis

Discussion

Findings:

Plain radiography showed Isthmic defect and spondylolisthesis.

No prevertebral soft tissue swelling was noted.

CT imaging clearly showed Isthmic defect on axial and sagittal images.

MR image demonstrated Isthmic defect without bone marrow edema suggesting no acute traumatic cause.

Differential Diagnosis: Fracture of pars interarticularis

Diagnosis: cervical Isthmic spondylolisthesis

Discussion:

- chondrification centers fuse, by week 8: mesenchymal vertebral bodyà cartilaginous VB

- begins the process of ossification three ossification centers by 7 years.

-secondary ossification centers rings on the sup/ inferior surface appear at puberty and fuse with the VB by the age of 25 years.

1. Neurocentral synchondrosis

  -- ossification failure of cartilage segments

2. Retrosomatic cleft

  -- hypoplasia or aplasia of pedicle  

  3. Spondylolysis

  -- repeated microtrauma and overuse  

   à stress Fx of pars interarticularis

4. Retroisthmic cleft

   = laminolysis : dorsal to inferior articular facet

  --  stress Fx from chronic mechanical overload

5. Paraspinous cleft and  spinous cleft

  -- d/ t failure of neural tube closure during development