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THE SIGNIFICANCE OF KNOWLEDGECONGENITAL CONDITIONS OF CERVICAL

SPINE IN TRAUMA SETTING

Milisic L, Hadzihasanovi B, Arslanagic Zuban J,

Hasanovic S, Kuskunovic A, Avdagic E.Clinic of Radiology,

Clinical Centre University of Sarajevo

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Emergency radiologic evaluation of the

cervical spine can be challenging even for the

most experinces radiologists . Knowledge of

the normal embryologic development and

anatomy of the cervical spine is important to

avoid mistaking congenital conditions for

fractures in the setting of trauma. Familiaritywith anatomic variants is also important for

correct image interpretation.

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Short review of the important embriological

facts concidering the cervical spine

The first two cervical vertebrae are unique intheir development. C1, or the atlas, is formedby three primary ossification sites: the

anterior arch and the two neural arches whichsurround the anterior arch and fuse later inlife to form the posterior arch.

There are four ossification centers for C2 atbirth: one for each neural arch, one for thebody, and one for the odontoid process.

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C3 through C7 can be discussed as a unit

because they exhibit the same developmental

pattern. Three ossification sites are present:

the body, which arises from a single

ossification site, and the two neural arches

The neural arches fuse posteriorly by age 23

years, and the body fuses with the neuralarches between 3 and 6 years of age

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The aim

The aim of this work is to show importance of

the knowlidge normal anatomic variants and

congenital conditions in trauma setting.

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Material and methodes:

Our trauma center is setted two years ago.

During that time we had many confusing cases

which have been causing some diagnostic

uncertainty. In this work we will present the

ones are the most common and difficult too.

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Congenital unfused posterior arch of C1

The neural arches fuse posteriorly by 3 years of age

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The patient had a car accident and brought to

the Trauma center.

He was very confused and did not complainon the cervical pain, but the X-ray was

performed routinly

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The X ray indicated that there was unilateral fasetal

dislocation on the level C7, so CT was performed

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On this axial CT scans we can see that

articular facets of C7 are missing...

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and there is a joint between the

articular facets of C6 and TH1

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Next patient has been

brought to the Trauma

centar after trauma and X-

rays was confusing. So weperformed the CT .Note

that mess between the

articular facets on the levelC4/C5. Is there a fracture or

not?

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On this CT scans we can se that upper articular facet C5

and lower of C4 are missing. This condition was

congenital.

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Axial scans on the level C4/C5

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Conclusion

Radiological examinations of the cervical spine

can be chalenging even for the most proficient

radiologist. In this short review we presented

some most typical and confusing cases.

Familiarity with anatomic variants and the normal

embryologic development of the cervical spine

has a key role in reliability and certainity in theinterpretation and it is our major guardian from

the heart atack in trauma setting.

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THANK YOU FOR YOUR ATTENTION!