Spondylolysis of C-2 in 2 athletically active individuals

Case report

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Cervical spondylolysis is an uncommon disorder involving a cleft at the pars interarticularis. It is most often found at the C-6 level, and clinical presentations have included incidental radiographic findings, neck pain, and rarely neurological compromise. Although subaxial cervical spondylolysis has been described in 150 patients, defects at the C-2 pedicles are rare.

The authors present 2 new cases of C-2 spondylolysis in athletically active young persons who did not demonstrate instability or neurological deficits, were able to remain active, and are being managed conservatively with serial examinations and imaging. They also discuss the results of 22 previously reported cases of C-2 spondylolysis. Based on the literature and their own experience, the authors conclude that most patients with C-2 spondylolysis remain neurologically intact, maintain stability despite the bony defect, and can be managed conservatively. Surgery is reserved for patients who demonstrate severe instability or spinal cord compromise due to stenosis.

Article Information

Address correspondence to: Oren N. Gottfried, M.D., Department of Neurosurgery, The Johns Hopkins Hospital, 600 North Wolfe Street, Meyer 7-109, Baltimore, Maryland 21287. email: ogottfr1@gmail.com.

© AANS, except where prohibited by US copyright law.

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    Cervical spine sagittal reconstruction (A) and axial (B) CT scans and flexion (C) and extension (D) radiographs obtained in a 16-year-old male triathlete who noted hypermobility of his neck. On CT scan, there is absence of bone at the junction of the C-2 pedicle and vertebral body (arrow) bilaterally and a pseudoarticulation of the bilateral pedicles of C-2 (arrow) with a capacious canal at the C2–3 level. There is no abnormal motion at the C-2 spondylolysis defect.

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    Cervical spine sagittal reconstruction (A) and axial (B) CT and lateral (C), flexion (D), and extension (E) radiographs obtained in a 23-year-old female college student who was incidentally discovered to have C-2 spondylolysis after being involved in minor accident. The CT images demonstrate a well-corticated, smooth cleft in the C-2 pedicles (white arrows) and similar defects at C3–5 (black arrows). The radiographs, including flexion and extension views, demonstrate bilateral spondylolysis defects at C-2 (white arrows) and also at C3–5 (black arrows) without evidence of abnormal motion at these levels. There are no signs of trauma including soft-tissue edema, hematoma, or ligamentous injury on these images, nor were there any on MR images.

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