Cervical Spondylolysis Research Articles

Safety profile of outpatient vs inpatient ACDF: An analysis of 33,807 outpatient ACDFs

IntroductionAnterior cervical discectomy and fusion (ACDF) is commonly performed to treat symptomatic cervical spondylolysis. Recently, many spine surgeons have begun performing ACDF in the outpatient setting. However, as this is a relatively new trend, many studies are either outdated or have small sample populations. The aim of this study was to evaluate outcomes following elective outpatient ACDF in comparison to those performed in the inpatient setting. MethodsPatients in Mariner Claims Database (2011–2017) undergoing outpatient elective ACDF were propensity score matched using age, gender and comorbidity burden. Chronic and peri-operative complications were assigned based on medical claims codes. All outcomes of interest were analyzed using multivariate logistic regression and compared to those undergoing inpatient ACDF. Significance was defined as p < 0.05 and adjusted with Bonferroni correction. ResultsOutpatient surgery had significantly lower risk of dysphagia within 24 h in both single (OR 0.44, p < 0.001) and multilevel ACDF (OR 0.48, p < 0.001). Patients undergoing outpatient procedures also have lower risk of 90-day minor (Single OR 0.64, p < 0.001; Multilevel OR 0.52, p < 0.001) and major (Single OR 0.48, p < 0.001; Multilevel OR 0.57, p < 0.001) medical complications. Outpatient procedures were also associated with decreased hospital resource utilization with a noted lower risk of subsequent hospital readmission (Single OR 0.71, p < 0.001; Multilevel OR 0.60, p < 0.001) and ER visits (Single OR 0.84, p < 0.001; Multilevel OR 0.87, p < 0.001). ConclusionOutpatient single and multilevel ACDF may be performed safely in properly selected patients. Since there are relatively low rates of readmission and significant complications within the days following outpatient ACDF, many surgeons should consider transitioning carefully selected patients to an outpatient setting.

Spondylolysis of the Cervical Spine (Case Report)

Cervical spondylolysis is a fairly rare clinical phenomenon that is mostly asymptomatic. The article describes a case of detection of bilateral cortical defects of pars interarticularis at the level of the CVI vertebra. Methods of computed tomography and magnetic resonance imaging were used for a comprehensive assessment of morphological changes.

"Tingling In The Scrum": Paresthesias And Neck Pain - Rugby

HISTORY: A 19 year old female college student “new to club rugby” presented to the campus health clinic for evaluation of neck stiffness and extremity tingling following last week’s practice. She was unable to recall a specific injury. However, she reported later feeling neck stiffness with associated soreness. She also reported paresthesias involving both hands, left worse than right, and her left foot. Her symptoms were improving but she had not resumed practice. She reported being a multi-sport high school athlete with participation in varsity field hockey and lacrosse without prior concussion, head or neck pain, or extremity abnormalities. She had also been in an auto accident years prior without subsequent injury. History was notable for resolved low back pain, and a family history of back pain. PHYSICAL EXAMINATION: Spine exam demonstrated FROM with no C/T/L spinous process tenderness. Spurling maneuver was negative. Tightness was appreciated in left trapezius muscle compared to right. Shoulders demonstrated FROM with normal rotator cuff strength. Upper and lower extremities with equal sensation, reflexes, and pulses. Grip strength normal. Straight leg raise and slump tests were negative. DIFFERENTIAL DIAGNOSIS: 1. Cervical strain 2. Herniated cervical disc 3. Cervical spondylolysis 4. Vertebral fracture 5. Spinal stenosis 6. Spinal infection 7. Autoimmune disease TESTS AND RESULTS: 1. Cervical spine x-rays: straightening without bony pathology 2. MRI brain & cervical spine: - Mild disc narrowing at C5-6 - Chiari I malformation with pointed tonsils herniated 1.1 cm from foramen magnum - Syrinx spanning C5-T4 with max diameter 3 mm in upper thoracic cord FINAL WORKING DIAGNOSIS: Chiari I malformation with C5-T4 syringomyelia TREATMENT AND OUTCOMES: The athlete was initially restricted from rugby activities until follow-up evaluation. She noted interval improvement and wished to pursue strength training at season end. Her symptoms then recurred with overhead lifting, and later with chiropractic treatments. Upon return to campus, brain and cervical MRI were ordered as recommended by a neurologist. Due to the above MRI findings, she stopped recreational activity and was referred for urgent neurosurgical evaluation. She will undergo decompression surgery.

Botulinum toxin a is effective to treat tension-type headache caused by hemifacial spasm

Abstract Objective We examined the relationship between hemifacial spasm (HFS; a form of cranio-cervical dystonia) and chronic primary headache, including tension-type headache (TTH). We also examined whether botulinum toxin A (BoNT/A) therapy for HFS ameliorates concomitant TTH. Methods Fifty-one HFS patients receiving BoNT/A therapy were recruited. Patients’ characteristics (including age, gender, chronic headache history, exercise habits, stiff neck, cervical spondylolysis history), stress factors, worsening/new onset of headache associated with HFS, and dose of BoNT/A were examined. We diagnosed headache types according to The International Classification of Headache Disorders, 3rd edition, beta. Numerical Rating Scale (NRS) and Headache Impact Test-6 (HIT-6) scores for headache severity were compared between the 6-week baseline before BoNT/A therapy and 6-week follow-up after BoNT/A therapy. Results Of 51 patients with HFS, 17 (33.3%) reported worsening or new onset of headache (especially TTH) associated with HFS (Group-S), and 34 were not aware of headache (Group-N). Twelve patients (70.6%) in group-S reported improvement of headache after BoNT/A therapy. NRS (from 7 [5–9] to 0 [0–5], p Conclusions Primary headache, especially TTH, is associated with HFS. BoNT/A therapy for HFS may also be indirectly effective for treatment of TTH.

Botulinum toxin A is effective to treat tension-type headache caused by hemifacial spasm

ObjectiveWe examined the relationship between hemifacial spasm (HFS; a form of cranio-cervical dystonia) and chronic primary headache, including tension-type headache (TTH). We also examined whether botulinum toxin A (BoNT/A) therapy for HFS ameliorates concomitant TTH. MethodsFifty-one HFS patients receiving BoNT/A therapy were recruited. Patients’ characteristics (including age, gender, chronic headache history, exercise habits, stiff neck, cervical spondylolysis history), stress factors, worsening/new onset of headache associated with HFS, and dose of BoNT/A were examined. We diagnosed headache types according to The International Classification of Headache Disorders, 3rd edition, beta. Numerical Rating Scale (NRS) and Headache Impact Test-6 (HIT-6) scores for headache severity were compared between the 6-week baseline before BoNT/A therapy and 6-week follow-up after BoNT/A therapy. ResultsOf 51 patients with HFS, 17 (33.3%) reported worsening or new onset of headache (especially TTH) associated with HFS (Group-S), and 34 were not aware of headache (Group-N). Twelve patients (70.6%) in group-S reported improvement of headache after BoNT/A therapy. NRS (from 7 [5–9] to 0 [0–5], p<0.01) and HIT-6 (from 55 [54–64] to 44 [36–52], p<0.001) scores were significantly improved after BoNT/A therapy. Logistic regression analysis revealed significant interaction between TTH associated with HFS and the presence of stress factors (odds ratio 43.11: 2.95–629.39, p<0.001) and history of chronic headache (odds ratio 28.53: 2.96–275.10, p<0.001). ConclusionsPrimary headache, especially TTH, is associated with HFS. BoNT/A therapy for HFS may also be indirectly effective for treatment of TTH.

Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability.

We report a case with compression myelopathy due to proliferative changes around the C2 pars defects without instability. A 69-year-old man presented with progressive clumsy hands and spastic gait. Plain radiographs showed bilateral spondylolysis (pars defects) at C2 and fusion between C2 and C3 spinous processes. Dynamic views revealed mobility through the pars defects, but there was no apparent instability. Computed tomography showed proliferative changes at the pars defects, which protruded into spinal canal. On magnetic resonance imaging, the spinal cord was compressed and intramedullary high signal change was found. A diagnosis of compression myelopathy due to proliferative changes around the C2 pars defects was made. We performed posterior decompression. Postoperatively, symptoms have been alleviated and images revealed sufficient decompression and no apparent instability. In patients with the cervical spondylolysis, myelopathy caused by instability or slippage have been periodically reported. The present case involving C2 spondylolysis is extremely rare.

Rare Bilateral C3 Cervical Spondylolysis: Report of Four Cases and a Literature Review

Objective To review and discuss the etiology, diagnosis and treatment C3 of bilateral cervical spondylolysis. Methods This was a retrospective review of the clinical features, imaginge findings, and treatment of 4 cases of bilateral C3 cervical spondylolysis, with a review of the literature. Results A 21-year-old woman, a 26-year-old man, a 14-year-old boy, and a 46-year-old man were diagnosed with bilateral C3 cervical spondylolysis. The patients had characteristic bilateral clefts between the articular pillar and the facets of C3, as well as spina bifida on CT. Although spondylolisthesis was not observed, spinal cord compression was definitive. All patients underwent posterior decompression with satisfactory results. Conclusions C3 cervical spondylolysis is rare condition. The cause is most likely congenital. Diagnosis is dependent on characteristic radiological features. Surgical treatment is the first choice.

Two Consecutive Levels of Unilateral Cervical Spondylolysis on Opposite Sides

Cervical spondylolysis is a rare condition defined as a corticated cleft between the superior and inferior articular facets of the articular pillar (1-3). Multilevel spondylolysis (4%) is uncommon (3-5). Bilateral involvement occurs in up to two-thirds of cases (2). To the best of our knowledge, this is the first report of two consecutive levels of unilateral cervical spondylolysis on opposite sides.

Rare bilateral C3 cervical spondylolysis:Report of four cases and a literature review

ObjectiveTo review and discuss the etiology, diagnosis and treatment C3 of bilateral cervical spondylolysis.MethodsThis was a retrospective review of the clinical features, imaginge findings, and t...

Bilateral C6 Spondylolysis With Spondylolisthesis in 3 Adolescent Siblings

Cervical spondylolysis with spondylolisthesis is a rare condition in the pediatric population. The nature of this condition and clinical presentation are important to provide appropriate management. This is a case report of 3 adolescent siblings who had C6 cervical spondylolysis with spondylolisthesis. Two cases were diagnosed insidiously with absence of neurological deficits and no instability on imaging and were treated conservatively. One case had a traumatic presentation associated with instability on imaging and was managed with cervical fusion and instrumentation. All 3 patients were doing well on a follow-up of >2 years. These cases suggest that cervical spondylolysis could be familial. The treatment was offered based on clinical presentation and presence of instability on radiographic studies. Level IV.

A commentary on cervical spondylolysis in the contact athlete

Cervical spondylolysis, unlike lumbar spondylolysis, is an exceedingly rare clinical entity. Perlman and Hawes [1] first described cervical spondylolysis and spondylolisthesis in 1951. To date, approximately 150 cases have been documented in the English language literature. Of these, approximately one-fourth have been described in the pediatric population. Cervical spondylolysis is characterized as a corticated cleft between the superior and inferior articular facets of the articular pillar. With the exception of C1, cervical spondylolysis has been reported at all cervical levels, with most cases occurring at C6. In fact, in 70 case reports by Hirota et al. [2], C6 was the most common site of involvement, present in 47 cases, whereas C2 and C5 were involved in only 9 cases each. Of the 47 patients with spondylosis at C6, 38 patients had bilateral involvement with associated spondylolisthesis. The age range at presentation is wide, with cases reported in those as young as 20 months and as old as 80 years. Twice as many cases have been found in males as in females [3,4]. Symptoms vary at presentation with most people noting minor axial neck pain and stiffness, often after a minor trauma. The etiology of cervical spondylolysis has not been established, with theories including congenital, developmental, microtrauma, and posttraumatic nonunion with pseudarthrosis [5]. Cervical spondylolysis is often seen in the context of other congenital abnormalities, such as spina

Progressively Unstable C2 Spondylolysis Requiring Spinal Fusion: Case Report

Cervical spondylolysis is a rare condition defined as a corticated cleft at the pars interarticularis in the cervical spine. This is the case of C2 spondylolysis demonstrating progressive significant instability, which was successfully treated by anterior cervical discectomy and fusion (ACDF) with cervical anterior plate. We describe a 20-year-old female with C2 spondylolysis presenting with progressive worsening of neck pain associated with progressive instability at the C2/3 segment. The progression of instability was well-documented on flexion-extension cervical spine x-rays. She was successfully treated by C2/3 ACDF with anterior cervical plate. Her preoperative significant neck pain resolved immediately after the surgical intervention. She was completely free from neurological symptoms at 1-year postoperative follow-up. We also review the literature and discuss 24 reported cases with C2 spondylolysis. When planning treatment, we should make sure to differentiate this pathology from acute traumatic fracture, which is a hangman's fracture. Assessment of C2/3 instability associated with neurological deficits is extremely important to consider management properly. C2/3 ACDF with cervical plate is biomechanically viable, less invasive, and provides adequate surgical stabilization for unstable C2 spondylolysis.

Spondylolysis of C-2 in children 3 years of age or younger: clinical presentation, radiographic findings, management, and outcomes with a minimum 12-month follow-up

Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist. The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2-3 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded. The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2-3 angulation, displacement, and width of pars defect were measured when available. The mean C2-3 angulation was 9.5° (range 1-34°), the mean C2-3 displacement was 4.78 mm (range 1.1-10.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9-7 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14-120 months). Based on the literature and the authors' own experience, they conclude that most very young children with C-2 spondylolysis remain neurologically intact and maintain stability in long-term follow-up despite the bony defect. This defect is often an asymptomatic incidental finding and may be managed conservatively. More aggressive therapy including surgery is indicated for those patients with a neurological deficit from spinal cord compromise secondary to stenosis and local C-2 kyphosis, progressive deformity, or worsening C2-3 instability.

Asymptomatic cervical isthmic spondylolisthesis and associated occult spinal bifida: a case report.

We report a case of rare cervical isthmic spondylolisthesis of C6-7 combined occult spinal bifida at C6, and review the radiologic finding, different diagnosis and treatment. A 23-year old female presented nuchal, back pain after traffic accident. Radiologic finding showed the 6th cervical isthmic defect, spondylolisthesis and dysplasia. The patient was conservatively treated about 8 weeks, and 10 months after injury, she was symptom free with full range of motion of cervical spine and she was followed up. Cervical spondylolysis is a very rare condition. This clinical importance is vulnerable to trauma. For whatever reasons, symptomatic patients need to be treated by conservative or surgical option.

Bilateral cervical spondylolysis of C7

Background context Cervical spondylolysis, which is defined as a cleft between the superior and inferior articular facets of the articular pillar, is a rare condition. The sixth cervical vertebra (C6) is the level most commonly affected. Cases involving C2, C3, C4, or C5 have also been reported. However, to date, no case of C7 spondylolysis has been reported. Purpose To present a rare case of bilateral spondylolysis of the seventh cervical vertebra (C7) in a 58-year-old man. Study design A case report. Methods A 58-year-old man visited our hospital with chronic posterior neck pain radiating to the left upper extremity. Magnetic resonance imaging (MRI) study revealed left foraminal disc herniations at C5–C6 and C6–C7. Cervical spondylolysis involving C7 was discovered incidentally during computed tomography (CT)–guided transforaminal steroid injection. Plain radiographs, CT images, and MRIs were reviewed thoroughly once again. Results The patient’s symptoms were relieved after he received CT-guided transforaminal steroid injections. Plain radiographs revealed a radiolucent defect in the articular pillar and cleft at the spinous process of C7. Computed tomography confirmed bilateral spondylolysis and spina bifida occulta of the C7 vertebra. Magnetic resonance imaging revealed absence of edema, which was suggestive of a chronic lesion. Conclusion Involvement of C7 is not exceptional in a case of cervical spondylolysis.

Spondylolysis of C-2 in 2 athletically active individuals

Cervical spondylolysis is an uncommon disorder involving a cleft at the pars interarticularis. It is most often found at the C-6 level, and clinical presentations have included incidental radiographic findings, neck pain, and rarely neurological compromise. Although subaxial cervical spondylolysis has been described in 150 patients, defects at the C-2 pedicles are rare. The authors present 2 new cases of C-2 spondylolysis in athletically active young persons who did not demonstrate instability or neurological deficits, were able to remain active, and are being managed conservatively with serial examinations and imaging. They also discuss the results of 22 previously reported cases of C-2 spondylolysis. Based on the literature and their own experience, the authors conclude that most patients with C-2 spondylolysis remain neurologically intact, maintain stability despite the bony defect, and can be managed conservatively. Surgery is reserved for patients who demonstrate severe instability or spinal cord compromise due to stenosis.

Cervical Spondylolysis

Case report. To describe a rare case of cervical spondylolysis with an adjacent secondary dysplastic change, and to review the current literature regarding cervical spondylolysis. Three patients presented with minor trauma history and radiographical C6 level spondylolysis. Cervical spines were analyzed with plain radiography, multidetector computerized tomography, and magnetic resonance imaging. In all 3 patients, plain radiographs revealed a bilateral cleft of the C6 articular mass. The patients presented with long-term minimal discomfort of the posterior neck. In 2 patients, a trauma event increased the pain and produced neurologic deficits. In addition, an adjacent dysplastic change was present on imaging studying in 2 of the patients, 1 of whom also presented with a cord signal change above the spondylolytic level. Early diagnosis and appropriate management of cases of spondylolysis are important. In addition, surgical plans for cervical spondylolysis should be considered if the adjacent levels are unstable or fragile.

Congenital Defect of the Posterior Arch of Cervical Spine : Report of Three Cases and Review of the Current Literature

Abnormalities of the posterior arch, including congenitally absent cervical pedicle and cervical spondylolysis, are rare entities that are usually found incidentally on neck radiographs. It is important to recognize these characteristic radiological features because their radiographic appearance may cause them to be confused with more serious entities such as fractures, locked facets, and tumor-induced bony erosions. Also, it is important to distinguish these abnormalities from similar pathologies to prevent the use of inappropriate treatment. We report the relevant clinical and radiological findings seen in three cases of posterior arch defect after trauma with review of pertinent literature.

Cervical spondylolysis in a judo player: a case report and biomechanical analysis

Dear Editor, I read with great interest the recent case report by Dr. Sasa et al. [1] regarding cervical spondylolysis in a judo player. The report was worthy of attention as it demonstrates the biomechanics of the cervical spine with spondylolysis at C6. Although they insist that no case reports of cervical spondylolysis among athletes have been reported; Amin et al. [2] reported C6 spondylolysis and spondylolisthesis secondary to bilateral stress fractures in a 16-year-old baseball player in 2006. The exact etiology of cervical spondylolysis is still debateable. Several theories have been proposed, including congenital anomaly, microtrauma, and posttraumatic nonunion with pseudoarthrosis [3]. Many authors believe the anomaly is congenital or due to faulty ossiWcation within the single ossiWcation center of the articular mass. With the reports by Amin et al. [2] and Sasa et al. [1] it has become more apparent that microtrauma or stress fracture is one of the causes of cervical spondylolysis. It is interesting that the most frequent level of congenital cervical spondylolysis is C6, which is the same level reported by Amin et al. and Sasa et al. in adolescent athletes [1, 2]. Therefore, it is meaningful to determine whether there is a preponderance of cervical spondylolysis at the C6 level in athletes or individuals who have repetitive stress due to occupation.

Bilateral congenital cervical spondylolysis

A 5-month-old boy with fever underwent neck radiography that incidentally showed posterior element defects at C4 (Fig. 1, arrows). He had no history of trauma. CT scan to evaluate the retropharyngeal soft tissues confirmed bilateral clefts at the pedicolaminar junction (Fig. 2, arrows). Sclerotic margins suggest a congenital rather than traumatic etiology. Congenital cervical spondylolysis, an embryologic developmental defect, occurs most commonly at C6. The overall frequency is unknown, and most cases are detected incidentally. Well-corticated margins differentiate congenital spondylolysis from acute fracture. Unlike congenitally absent pedicle, there is no transverse process dysplasia or apparent neural foraminal enlargement [1].