Cervical spondylolysis: imaging findings in 12 patients

Area of Science:

• Radiology
• Orthopedic Surgery
• Anatomy

Background:

• Cervical spondylolysis is a rare congenital condition characterized by a cleft in the articular pillar.
• It is the cervical spine equivalent of lumbar spondylolysis (pars interarticularis defect).
• Misdiagnosis is common, especially in trauma patients, necessitating accurate differentiation from fractures or dislocations.

Purpose of the Study:

• To detail the radiologic features of cervical spondylolysis.
• To improve recognition and differentiation from traumatic injuries.
• To highlight characteristic imaging findings in a cohort of patients.

Main Methods:

• Retrospective review of 12 patients diagnosed with cervical spondylolysis.
• Correlation of plain film radiography with advanced imaging: hypocycloidal tomography, CT, and MRI.
• Analysis of lesion location (C4 and C6 levels) and laterality (unilateral/bilateral).

Main Results:

• Seven patients had C6 spondylolysis (3 bilateral), and five had C4 spondylolysis (all unilateral).
• Nine out of 12 patients were initially misdiagnosed.
• Characteristic features include a well-defined cleft, triangular pillar fragments, posterior displacement, pedicle hypoplasia, spina bifida, and compensatory pillar changes.

Conclusions:

• Cervical spondylolysis requires heightened radiologic awareness for accurate diagnosis.
• Characteristic imaging findings aid in differentiating it from traumatic articular pillar fractures or dislocations.
• A multi-imaging approach may be necessary to confirm the diagnosis.