Milisic L, Hadzihasanovi B, Arslanagic Zuban J, Hasanovic S, Kuskunovic A, Avdagic E.

Clinic of Radiology, Clinical Centre University of Sarajevo

THE SIGNIFICANCE OF KNOWLEDGE CONGENITAL CONDITIONS OF CERVICAL SPINE IN TRAUMA SETTING

 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. Familiarity with anatomic variants is also important for correct image interpretation.

Short review of the important embriological facts concidering the cervical spine The first two cervical vertebrae are unique in their development. C1, or the atlas, is formed by three primary ossification sites: the anterior arch and the two neural arches which surround the anterior arch and fuse later in life to form the posterior arch. There are four ossification centers for C2 at birth: one for each neural arch, one for the body, and one for the odontoid process.

 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 2 3 years, and the body fuses with the neural arches between 3 and 6 years of age

The aim
The aim of this work is to show importance of the knowlidge normal anatomic variants and congenital conditions in trauma setting.

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.

Congenital unfused posterior arch of C1

The neural arches fuse posteriorly by 3 years of age

 The patient had a car accident and brought to the Trauma center. He was very confused and did not complain on the cervical pain, but the X-ray was performed routinly

The X ray indicated that there was unilateral fasetal dislocation on the level C7, so CT was performed

On this axial CT scans we can see that articular facets of C7 are missing...

and there is a joint between the articular facets of C6 and TH1

Next patient has been brought to the Trauma centar after trauma and Xrays was confusing. So we performed the CT .Note that mess between the articular facets on the level C4/C5. Is there a fracture or not?

On this CT scans we can se that upper articular facet C5 and lower of C4 are missing. This condition was congenital.

Axial scans on the level C4/C5

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 the interpretation and it is our major guardian from the heart atack in trauma setting.

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