Spinal canal stenosis at the level of Atlas

Abstract

We report here a rare case of high cervical stenosis at the level of atlas who presented with progressively deteriorating quadriparesis and respiratory distress. A 10-year-old boy presented with above symptoms of one-year duration with a preceding history of trivial trauma prior to onset of such symptoms. Cervical spine MRI revealed a significant stenosis at the level of atlas from the posterior side with a syrinx extending above and below. High-resolution computed tomography of the above level yielded an ill-defined osseous bar compressing the canal at the level of C1 posterior arch, which appeared bifid in the midline. The patient was immediately taken up for surgery in view of his respiratory complaints. The child showed an excellent recovery after excision of the posterior arch of atlas and removal of the compressing osseous structure.

Congenital malformed posterior arch of atlas with fusion defect: a case of developmental canal stenosis causing cervical myelopathy

“…The present case remains distinct as the midline anomalous osseo-cartilaginous mass was severely hypertrophied to cause spinal canal stenosis at the level of atlas causing cervical myelopathy due to the malformation. Cervical stenotic myelopathy is a common presentation in the subaxial cervical spine involvement (2,15). The midsagittal canal diameter at the level of atlas in the present case was 6.36 mm, whilst the normal sagittal diameter at the level of atlas is reported to be 16-25 mm (2,3,16).…”

“…Cervical stenotic myelopathy is a common presentation in the subaxial cervical spine involvement (2,15). The midsagittal canal diameter at the level of atlas in the present case was 6.36 mm, whilst the normal sagittal diameter at the level of atlas is reported to be 16-25 mm (2,3,16). While significant cervical cord compression occurs if the sagittal canal diameter is <14 mm at the level of atlas; myelopathic signs and symptoms develop when the diameter falls <10 mm (17,18).…”

“…Congenital anomalies of PAA have a wide spectrum of presentation, ranging from failure of posterior midline fusion with a cartilaginous cleft to complete aplasia of PAA. Incidence of PAA defects has been reported between 0.69% to 4% (2,3,8,(11)(12)(13). Currarino (14) classified these defects into five types, as shown in Table 1.…”

“…Upper cervical stenosis is a relatively rare entity, being either congenital or acquired in origin. While the acquired causes vary from infection and trauma to rheumatoid arthritis; congenital causes include os odontoideum, congenital clefts or aplasias of the arches of atlas, hypertrophy of the dens, lateral masses or the transverse atlantal ligament, either of which may rarely present as cervical myelopathy (2)(3)(4). Congenital anomalies of the posterior arch of the atlas (PAA) although rare, are well documented, being usually asymptomatic and diagnosed incidentally (5)(6)(7).…”

“…The patient presented with pain radiating to one half of the body with tingling and numbness in the same half with upper motor neuron lesion signs in all four limbs. Almost a third of the patients with PAA defects are reported to remain asymptomatic (6); in the symptomatic patients, the presentation varies from neck pain and occipitalgia (9), to neurological paraesthesia and frank myelopathy (5,6,11) and to extremely crippling reports of progressively deteriorating quadriparesis with respiratory distress (2). Although the arch defect is of congenital origin, manifestation is usually delayed into adulthood.…”