Atlantoaxial pseudoarticulation as a cause of neck pain: case illustration

Andrew B. Boucher, Osama N. Kashlan, Matthew F. Gary and Daniel Refai
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Department of Neurosurgery, Emory University, Atlanta, Georgia
DOI:
https://doi.org/10.3171/2018.8.SPINE18918
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Pseudoarticulation in the setting of lumbosacral transitional vertebrae, named Bertolotti syndrome, is present in approximately 12.5% of the population, may often be confused with other etiologies of lumbosacral back pain, and can be difficult to diagnose.1 Anesthetic injections into the pseudoarticulation, also termed a false or rudimentary joint, have a therapeutic effect and can be used as a diagnostic measure to predict who may benefit from surgical intervention in patients in whom conservative therapy fails.2 Although well characterized in the lumbosacral spine, pseudoarticulation in the cervical spine has never, to our knowledge, been reported

Volume 30: Issue 2 (Feb 2019): Pages 149-297

in Journal of Neurosurgery: Spine
Cover Journal of Neurosurgery: Spine

Article Information

Correspondence Andrew B. Boucher: Emory University, Atlanta, GA. abbouch@emory.edu.

INCLUDE WHEN CITING Published online November 2, 2018; DOI: 10.3171/2018.8.SPINE18918.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

Keywords:
pseudoarticulation; rudimentary joint; false joint; Bertolotti syndrome; neck pain; cervical spine; atlantoaxial
Page Count:
182–183

© AANS, except where prohibited by US copyright law.

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    Left C1–2 hemilaminectomy for removal of left atlantoaxial pseudoarticulation. A: Preoperative sagittal CT scan slightly to the left of midline demonstrates the C1–2 false joint. B: Preoperative lateral upright radiograph shows the lesion seen on CT (in panel A). Of note, there was no instability on dynamic flexion-extension radiographs. C: Preoperative axial T2 MR image shows the pseudoarticulation with mass effect on the spinal cord. D: Postoperative radiograph illustrates the absence of the resected pseudoarticulation and the remaining normal posterior ring of C1. The red circles throughout the figure highlight the lesion further. Figure is available in color online only.

Left C1–2 hemilaminectomy for removal of left atlantoaxial pseudoarticulation. A: Preoperative sagittal CT scan slightly to the left of midline demonstrates the C1–2 false joint. B: Preoperative lateral upright radiograph shows the lesion seen on CT (in panel A). Of note, there was no instability on dynamic flexion-extension radiographs. C: Preoperative axial T2 MR image shows the pseudoarticulation with mass effect on the spinal cord. D: Postoperative radiograph illustrates the absence of the resected pseudoarticulation and the remaining normal posterior ring of C1. The red circles throughout the figure highlight the lesion further. Figure is available in color online only.

References

1

Jancuska JMSpivak JMBendo JA: A review of symptomatic lumbosacral transitional vertebrae: Bertolotti’s syndrome. Int J Spine Surg 9:422015

2

Jönsson BStrömqvist BEgund N: Anomalous lumbosacral articulations and low-back pain. Evaluation and treatment. Spine (Phila Pa 1976) 14:831–8341989

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