Asymptomatic Osseous Loose Body in the Cervical Spine

Abstract

Loose bodies, or osteochondral fragments, are commonly found in human joints. They are presumed to arise from trauma, joint disintegration (for example, degenerative changes), or synovial proliferation1. The natural history of loose bodies in synovial joints is slow enlargement with deposition of additional surface layers. However, if the loose body becomes trapped and reattaches to the synovium, it is then generally reabsorbed. Neuropathic or degenerative joints with hyperemic or inflamed synovium are particularly prone to the development of loose bodies, but they also tend to rapidly reabsorb them2. Histological studies have generally demonstrated varying amounts of osseous, cartilaginous, and fibrous tissue with living and dead osteocytes, chondrocytes, osteoclasts, and osteoblasts found in the tissue layers. No blood supply nourishes these loose bodies; therefore, they derive sustenance from the synovial fluid alone3. We report the case of a patient with an asymptomatic, osseous loose body lying in the spine canal. To our knowledge, this is the first time this condition has been reported in the literature. An eighty-seven-year-old female restrained driver was involved in a low-speed motor-vehicle accident and sustained an open left tibiotalar fracture-dislocation. She had no loss of consciousness and had no pain, numbness, or weakness in the neck and/or the upper extremities. She reported no previous history of neck pain or upper-extremity radicular symptoms. Examination revealed no tenderness of the paraspinal tissues or the spinous processes; neurological examination of all four limbs was normal. There was full painless range of motion of the cervical spine, with no Hoffmann sign. The left ankle wound was irrigated, the fracture-dislocation was reduced, and the ankle was placed in a splint in the emergency department. Routine trauma radiographs, including radiographs of the …