Fracture of an ossified transverse ligament. Case report

Cervical myelopathy due to ossification of the transverse atlantal ligament: a Caucasian case report operated on and literature analysis

One case of cervical myelopathy associated to ossification of transverse atlantal ligament (OTAL) and C1 posterior arch hypoplasia in a Caucasian adult female is reported. A 53-year-old female affected by cervical myelopathy was treated with C1 laminectomy and posterior arthrodesis. CT scan demonstrated that the distance between ossification of the ligament and anterior cortex of the posterior arch of atlas was 6,2mm leading to consistent space reduction for spinal cord at this level. Patient underwent spinal cord decompression and fixation with C1 poliaxial screws in lateral masses and two bilateral crossing C2 laminar screws with an improvement of neurological functions at 4-years follow-up. The association between OTAL and C1 hypoplasia was reported in very few cases. The treatment with C1 laminectomy without fusion is reported in medical literature with good clinical outcome. Our patient obtained a neurological improvement at midterm follow-up with spinal cord decompression and fusion.

Cervical myelopathy caused by anomalies at the level of atlas

STUDY DESIGN

Case report.

OBJECTIVE

To report a case of cervical myelopathy due to simultaneous anomalies at the level of atlas involving hypoplasia of the posterior arch of the atlas, partial ossification of the transverse atlantal ligament, and hypertrophy of the dens.

SUMMARY OF BACKGROUND DATA

Hypoplasia of the posterior arch of the atlas, ossification of the transverse atlantal ligament, and hypertrophy of the dens are all individually very rare clinical entities. We are not aware of previous reports describing the association of hypoplasia of the posterior arch of the atlas, partial ossification of the transverse atlantal ligament, and hypertrophy of the dens.

METHODS

The patient's medical history, physical examination, and radiographic evaluation are examined. Surgical treatment and clinical outcome are reported. In addition, available literature is also reviewed.

RESULTS

The patient's neurologic symptoms significantly improved after posterior decompressive surgery.

CONCLUSION

We believe this is the first case of cervical myelopathy caused by simultaneous anomalies at the level of atlas involving hypoplasia of the posterior arch of the atlas, partial ossification of the transverse atlantal ligament, and hypertrophy of the dens. Surgical intervention improved the neurologic impairment.

Ossification of the posterior atlantoaxial membrane and the transverse atlantal ligament

STUDY DESIGN

Case report.

OBJECTIVE

To report a case of ossification of the posterior atlantoaxial membrane (PAAM) and ossification of the transverse ligament of the atlas (TAL).

SUMMARY OF BACKGROUND DATA

Ossification of the PAAM and TAL are both very rare clinical entities. This is the first case involving ossification of both the PAAM and TAL with the development of cervical myelopathy.

METHODS

Patient's history, physical examination, radiographic evaluation, surgical treatment, and outcome are examined. Relevant literature is also reviewed.

RESULTS

The patient's neurological symptoms significantly improved after posterior decompressive surgery.

CONCLUSION

Ossification of various parts of the spinal ligament have been reported previously. Among them, ossification of both the PAAM and TAL has never been reported previously and is thus extremely rare. Surgical intervention improved the neurological impairment.

Occipital neuralgia secondary to hypermobile posterior arch of atlas. Case report

The authors report on the management of occipital neuralgia secondary to an abnormality of the atlas in which the posterior arch was separated by a fibrous band from the lateral masses, resulting in C-2 nerve root compression. The causes and treatments of occipital neuralgia as well as the development of the atlas are reviewed.