DR. MARSHALL DELTOFF, DC 2022-07-13 05:37:16
What do the x-rays say?
Welcome to the re-birth of the “X-Files,” a column dedicated to bringing you a variety of x-ray cases and all things radiology. Our first case: A 36-year-old woman presented with neck/shoulder pain that has recently gotten worse over the last week, which she attributes to a new chair she’s using at home.
She rated the pain intensity 5/10 with her posture affecting the intensity, as she commented it is difficult to get comfortable. Cervical ROM exhibited severe restriction in LLF and LR, and moderate restriction in RR and RLF; the left scapular pain becomes more pronounced with right head rotation. Cervical spine flexion was also limited, but extension was full. She gets headaches a couple of times a month.
She had previously been to chiropractors, was x-rayed three years ago and informed that “something was missing in her upper C-spine” on the films.
Additional history: She has been involved in three car accidents: two high speed (2004 and 2006) and one low speed fender bender last year. Wisdom teeth (four) were pulled in 2000 and she had jaw surgery in 2011. (The patient was given the option for braces or to have surgery. She opted for surgery: Surgeons broke her jaw and moved it forward 3 mm)
WHAT IS YOUR DIAGNOSIS?
• A) Lytic metastasis?
• B) Surgical removal of posterior arch of atlas?
• C) Congenital absence of posterior arch of atlas?
• D) Very old healed fracture of atlas, with resorption of posterior arch?
• E) Partial atlas occipitalization?
ANSWER:
Correct answer is “C”: Congenital absence = agenesis of Atlas.
The radiographic clues are: the enlarged anterior tubercle of atlas (stress hypertrophy)the larger than normal “megaspinous” of axis (representing fusion of the rudimentary posterior arch and posterior tubercle of the atlas to the axis spinous process).
DR. MARSHALL DELTOFF, DACBR, FCCR(C), FEAC is a Professor of Radiology at Barcelona College of Chiropractic. He offers an online x-ray reporting service for colleagues in Spain and worldwide.
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The X-Files
https://magazine.canadianchiropractor.ca/article/The+X-Files/4308240/753421/article.html