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Ossification of the posterior atlantoaxial membrane associated with atlas hypoplasia

View Article: PubMed Central - PubMed

ABSTRACT

Rationale:: Hypoplasia with an intact posterior arch of the atlas and ossification of the posterior atlantoaxial membrane (PAAM) are individually rare.

Patient concerns:: The patient presented with a 6-month history of progressive weakness and paresthesia of his lower extremities.

Diagnoses:: Cervical myelopathy resulting from atlas hypoplasia and ossification of the posterior atlantoaxial membrane.

Interventions:: Laminectomy of the atlas with duroplasty.

Outcomes:: Preoperative symptoms were alleviated.

Lessons:: In most reported cases, either atlas hypoplasia or ossification of the PAAM is responsible for patients’ myelopathy. The case illustrated here, to the best of our knowledge, is the first one with coexistent atlas hypoplasia and ossification of the PAAM. And laminectomy of the atlas with duroplasty provided satisfied outcome.

No MeSH data available.


Related in: MedlinePlus

CT of the cervical spine. (A) Sagittal CT demonstrates osseous mass exists between the inferior border of the posterior arch of C1 and superior border of the lamina of C2. (B) Axial CT at the level of atlas shows a small inner sagittal diameter of 23 mm. (C) Axial CT at the atlantoaxial level shows ossified PAAM causing cervical canal stenosis.
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Figure 2: CT of the cervical spine. (A) Sagittal CT demonstrates osseous mass exists between the inferior border of the posterior arch of C1 and superior border of the lamina of C2. (B) Axial CT at the level of atlas shows a small inner sagittal diameter of 23 mm. (C) Axial CT at the atlantoaxial level shows ossified PAAM causing cervical canal stenosis.

Mentions: Lateral cervical X-rays revealed narrowing of the spinal canal at the atlas level, with space available for the spinal cord (SAC) of 10 mm (Fig. 1A). And SAC decreased to 6 mm with flexion of the neck (Fig. 1B). Open-mouth view showed mild instability of atlantoaxial joint (Fig. 1C). Cervical computed tomography (CT) scan revealed severe cervical canal stenosis, ossification of the PAAM and a hypoplastic atlas with inner sagittal diameter of 23 mm (Fig. 2). Magnetic resonance (MR) scan revealed severe spinal cord compression with a dural sac sagittal diameter of 5.7 mm in the atlantoaxial region (Fig. 3). The T2-weighted imaging confirmed constriction of the dural sac and an intramedullary high intensity area. Therefore, atlas hypoplasia and ossification of the PAAM were thought to cause myelopathy together.


Ossification of the posterior atlantoaxial membrane associated with atlas hypoplasia
CT of the cervical spine. (A) Sagittal CT demonstrates osseous mass exists between the inferior border of the posterior arch of C1 and superior border of the lamina of C2. (B) Axial CT at the level of atlas shows a small inner sagittal diameter of 23 mm. (C) Axial CT at the atlantoaxial level shows ossified PAAM causing cervical canal stenosis.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5134809&req=5

Figure 2: CT of the cervical spine. (A) Sagittal CT demonstrates osseous mass exists between the inferior border of the posterior arch of C1 and superior border of the lamina of C2. (B) Axial CT at the level of atlas shows a small inner sagittal diameter of 23 mm. (C) Axial CT at the atlantoaxial level shows ossified PAAM causing cervical canal stenosis.
Mentions: Lateral cervical X-rays revealed narrowing of the spinal canal at the atlas level, with space available for the spinal cord (SAC) of 10 mm (Fig. 1A). And SAC decreased to 6 mm with flexion of the neck (Fig. 1B). Open-mouth view showed mild instability of atlantoaxial joint (Fig. 1C). Cervical computed tomography (CT) scan revealed severe cervical canal stenosis, ossification of the PAAM and a hypoplastic atlas with inner sagittal diameter of 23 mm (Fig. 2). Magnetic resonance (MR) scan revealed severe spinal cord compression with a dural sac sagittal diameter of 5.7 mm in the atlantoaxial region (Fig. 3). The T2-weighted imaging confirmed constriction of the dural sac and an intramedullary high intensity area. Therefore, atlas hypoplasia and ossification of the PAAM were thought to cause myelopathy together.

View Article: PubMed Central - PubMed

ABSTRACT

Rationale:: Hypoplasia with an intact posterior arch of the atlas and ossification of the posterior atlantoaxial membrane (PAAM) are individually rare.

Patient concerns:: The patient presented with a 6-month history of progressive weakness and paresthesia of his lower extremities.

Diagnoses:: Cervical myelopathy resulting from atlas hypoplasia and ossification of the posterior atlantoaxial membrane.

Interventions:: Laminectomy of the atlas with duroplasty.

Outcomes:: Preoperative symptoms were alleviated.

Lessons:: In most reported cases, either atlas hypoplasia or ossification of the PAAM is responsible for patients’ myelopathy. The case illustrated here, to the best of our knowledge, is the first one with coexistent atlas hypoplasia and ossification of the PAAM. And laminectomy of the atlas with duroplasty provided satisfied outcome.

No MeSH data available.


Related in: MedlinePlus