Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis

C2 semisegmented hemivertebra - a rare anomaly presenting with torticollis

BACKGROUND

Cervical hemivertebrae are extremely rare anomalies which usually present with restriction of neck movements and torticollis in childhood. Hemivertebrae within the craniovertebral junction have only been reported once previously in the literature. We report a case of semisegmented C2 vertebra presenting in a young adult with cervical pain and torticollis with no other associated anomalies.

CASE DESCRIPTION

A 21-year-old lady presented with a history of neck pain for the past 10 days and longstanding torticollis with head tilt to the left. Computed tomographic scan of the cervical spine revealed a semisegmented hemivertebra located laterally between the C1 lateral mass and C2 on the right side which was not associated with any other bony anomalies, scoliosis or atlantoaxial dislocation. Conservative treatment with physical therapy was the chosen therapeutic strategy.

CONCLUSION

Hemivertebrae within the craniovertebral junction are exceedingly rare anomalies which may present with pain and deformity in childhood and are an important cause of congenital torticollis which may be associated with other spinal, craniofacial, cardiac or renal anomalies.

A novel classification of subaxial cervical hemivertebrae and associated surgical management

Objective

To propose and validate a new classification of surgical methods for patients with subaxial cervical hemivertebrae.

Method

This article reviewed cases diagnosed with subaxial cervical hemivertebrae in our hospital from January 2008 to December 2019. The results of preoperative (initial visit), postoperative and/or final follow-up were assessed using the Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, spinal balance parameters, and Scoliosis Research Society-22 Questionnaire (SRS-22). We also performed a reliability study to assess this classification.

Result

The classification includes three types. Each type can be divided into two subtypes, and a preliminary algorithm is proposed. Type I: There is an obvious appearance deformity in the neck, there are hemivertebrae in the cervical spine, and only a single hemivertebra of the subaxial cervical hemivertebra needs to be resected. Type II: There is an obvious appearance deformity in the neck, there are hemivertebrae in the cervical spine, and multiple subaxial cervical hemivertebrae need to be removed. Type III: No apparent deformity in the neck, at least one subaxial cervical hemivertebra existed or Klipper-Feil syndrome. Each type is divided into two subtypes, A and B, according to whether the upper and lower adjacent vertebral bodies of the rescected hemivertebra(e) are fused. We propose corresponding treatment methods for different types. We included a total of 121 patients and reviewed the prognosis for each type of patient. All patients achieved satisfactory results. The reliability study showed that the mean interobserver agreement was 91.8% (89.3%–93.4%), and the κ value was 0.845 (0.800–0.875). The intraobserver agreement ranged from 93.4% to 97.5%, with a mean κ value of 0.929 (0.881 to 0.954).

Conclusion

In our study, we proposed and validated a new classification of subaxial cervical hemivertebrae and proposed corresponding treatment plans for different classifications.

Severe kyphoscoliosis in a 17-year-old patient with T11-T12 hemivertebra: X-ray imaging of the abnormal anatomy of the thoracolumbar spine

Young patient exhibiting lumbar pain accompanied by severe kyphoscoliosis-hemivertebra of the thoracolumbar spine; a rare etiology with difficult surgical treatment.

Anatomical Variations That Can Lead to Spine Surgery at the Wrong Level: Part I, Cervical Spine

Spine surgery at the wrong level is an adversity that many spine surgeons will encounter in their career, and it falls under the wrong-site surgery sentinel events reporting system. The cervical spine is the second most common location in the spine at which surgery is performed at the wrong level. Anatomical variations of the cervical spine are one of the most important incriminating risk factors. These anomalies include craniocervical junction abnormalities, cervical ribs, hemivertebrae, and block/fused vertebrae. In addition, patient characteristics, such as tumors, infection, previous cervical spine surgery, obesity, and osteoporosis, play an important role in the development of cervical surgery at the wrong level. These were described, and several effective techniques to prevent this error were provided. A thorough review of the English-language literature was performed in the database PubMed between 1981 and 2019 to review and summarize these risk factors. Compulsive attention to these factors is essential to ensure patient safety. Therefore, the surgeon must carefully review the patient's anatomy and characteristics through imaging and collaborate with radiologists to reduce the likelihood of performing cervical spine surgery at the wrong level.

Pathological Features and Surgical Strategies of Cervical Deformity

Cervical deformity (CD) is a kind of disorder influencing cervical alignment. Although the incidence of CD is not high, this deformity can cause not only pain but also difficulties in daily activities such as swallowing and maintaining upright position. Even though the common cause of cervical deformity is still controversial, previous studies divided CD into congenital deformity and secondary deformity; secondary deformity includes iatrogenic and noniatrogenic deformity according to pathogenic factors. Due to the lack of relevant studies, a standardized evaluation for CD is absent. Even though the assessment of preoperative condition and surgical planning mainly rely on personal experience, the evaluation methods could still be summarized from previous studies. The objective in this article is to summarize studies on cervical scoliosis, identify clinical problems, and provide directions for researchers interested in delving deep into this specific topic. In this review, we found that the lack of standard classification system could lead to an absence of clinical guidance; in addition, the osseous landmarks and vascular distributions could be variable in CD patients, which might cause the risk of vascular or neurological complications; furthermore, multiple deformities were usually presented in CD patients, which might cause chain reaction after the correction of CD; this would prevent surgeons from choosing realignment surgery that is effective but risky.

Hemivertebra of the cervical spine: an uncommon background for neck pain, cervical scoliosis, and torticollis

A 15‐year‐old female patient presented with neck pain accompanied by cervical scoliosis, on the existence of torticollis. Although rare, hemivertebra of the cervical spine is a congenital deformation associated with these three clinical features.