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Morimoto LR, Kase DT, Esmanhotto PG, Maciel MA, Augusto ACL, Catricala PF, Anaya JEC, Mukherjee S, Fernandes ARC, Aihara AY. Imaging Assessment of Nontraumatic Pathologic Conditions at the Craniovertebral Junction: A Comprehensive Review. Radiographics 2024; 44:e230137. [PMID: 38635454 DOI: 10.1148/rg.230137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Nontraumatic pathologic conditions of the craniovertebral junction encompass a range of conditions affecting the complex anatomy of this region without direct physical injury. These conditions include congenital syndromes that predispose individuals to ligamentous laxity, potentially leading to instability. Additionally, rare but noteworthy cases such as Grisel syndrome, a cause of pediatric torticollis, may arise without a traumatic trigger. Inflammatory diseases, including rheumatoid arthritis, ankylosing spondylitis, and crystal deposition, can lead to cervical instability and spinal cord compression. Infections at the upper cervical spine are dominated by tuberculosis, typically transmitted through hematologic or lymphatic routes with characteristic imaging findings. On the other hand, purulent bacterial infections in this area are rare. Furthermore, although tumors involving the structures of the craniovertebral junction are infrequent, they can lead to significant complications, albeit less frequently through cord compression and more commonly via pathologic fractures or subluxation. The craniocervical junction is a complex anatomic region comprising ligaments, bones, joints, and muscles that support the head's weight and enable its wide range of motion. Accurate recognition and understanding of the complex anatomy and the various nontraumatic pathologic conditions at the craniovertebral junction are pivotal for initiating timely and appropriate treatment strategies. ©RSNA, 2024 Test Your Knowledge questions for this article are available in the supplemental material.
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Affiliation(s)
- Letícia R Morimoto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Daisy T Kase
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Paola G Esmanhotto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Murilo A Maciel
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Ana C L Augusto
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Patrick F Catricala
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Julia E C Anaya
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Sugoto Mukherjee
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - Artur R C Fernandes
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
| | - André Y Aihara
- From the Department of Diagnostic Imaging, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros 800, Vila Clementino, São Paulo, SP 04024-002, Brazil (L.R.M., D.T.K., P.G.E., A.C.L.A., P.F.C., A.R.C.F., A.Y.A.); Dasa Institute for Education and Research (IEPD), Rio de Janeiro, Brazil (D.T.K., P.G.E., M.A.M., A.C.L.A., P.F.C., J.E.C.A., A.Y.A.); Department of Radiology, A.C. Camargo Cancer Center, São Paulo, Brazil (M.A.M.); Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Va (S.M.); and Group of Radiology and Diagnostic Imaging, Rede D'Or São Paulo, São Paulo, Brazil (A.R.C.F.)
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Kuang GM, Loo NN, Gao Q, Li J, Luo L, Chen S, Cheung JPY, Cheung KMC. A solitary osteolytic lesion with pathological fracture in the cervical spine - a case report. BMC Musculoskelet Disord 2023; 24:436. [PMID: 37254107 PMCID: PMC10228027 DOI: 10.1186/s12891-023-06543-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/16/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND Langerhans cell histiocytosis (LCH) is a rare disorder. The treatment options vary depending on how many organs are involved and how extensive the disease is. In this report, a case of LCH with isolated 6th cervical vertebra (C6) collapse was presented. This case was treated with anterior corpectomy and instrumented fusion, followed by local radiotherapy (RT), with a good clinical outcome up to postoperative six months. CASE PRESENTATION This was a 47-year-old female patient with a complaint of neck pain and bilateral shoulder pain for two months before consultation. She was initially treated with analgesics, but the pain was persistent. Further radiological evaluations revealed an osteolytic lesion within the C6 vertebral body with a pathological fracture. Magnetic resonance imaging (MRI) with contrast of the cervical spine revealed diffused hypointense signal changes on the T1-weighted images and hyperintense signal changes on the T2-weighted images in the C6 vertebral body, with significant contrast-enhanced infiltration signals. Furthermore, in positron emission tomography-computed tomography (PET-CT), focal hypermetabolism and abnormal uptake signals were seen only in the C6 vertebral body. The patient underwent an anterior cervical corpectomy with instrumented fusion. The histopathological results confirmed the diagnosis of LCH. The patient reported significant pain relief on postoperative day one. Moreover, she was treated by local RT at postoperative one month. Good clinical outcomes were achieved in the form of no pain and recovery in neck mobility up to postoperative six months. No evidence of recurrence was observed at the final follow-up. CONCLUSIONS This case report describes a treatment option for a solitary C6 collapse with LCH managed by anterior corpectomy and instrumented fusion, followed by local RT, with a good clinical outcome at postoperative six months. More studies are needed to elucidate whether such a treatment strategy is superior to surgery or RT alone.
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Affiliation(s)
- Guan-Ming Kuang
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China.
| | - Nga-Nuen Loo
- International school, Jinan University, Guangzhou, Guangdong, China
| | - Qingpeng Gao
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jishi Li
- Department of Oncology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Lin Luo
- Department of Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Shuang Chen
- Department of Pathology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
| | - Kenneth M C Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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