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Joseph Junewick, MD FACR
over 7 years ago
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Congenital C4 Spondylolysis

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Developmental or Congenital
Created: over 7 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: CT
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15 year old involved in motor vehicle accident.

Case Images


Congenital C4 Spondylolysis


CT- multiplanar images show left-sided spondylolysis with subtle pedicolaminar hypoplasia and dysplastic facet.


Cervical spondylolysis is defined as a deficiency of the articular pillar. It is frequently an incidental finding on studies related to trauma or pain and much more rare than lumbar spondylolysis. Spondylolysis is probably congenital but could be related to repetitive microtrauma or post traumatic nonunion.

The imaging findings reported include an articular pillar cleft, triangular pillar fragments, hypoplasia of the ipsilateral pedicle, dysplastic ipsilateral laminae, and spina bifida. The cleft is oriented obliquely to the plane of the facet joint, ranging from vertical to perpendicular to the joint. Compensatory hypertrophic changes of the articular process in the adjacent vertebrae and spondylolisthesis are frequently seen.

Most patients with cervical spondylolysis have normal neurologic examination results; myelopathy may occur with spondylolistheis. The most commonly affected cervical level is C6, followed in frequency by C4. Cervical spondylolysis is probably more common in males. It is important to differentiate spondylolysis from acute fracture since the management is often conservative and surgical respectively.


Schwartz JM. Bilateral cervical spondylolysis. Radiology (2001); 220:191-194.

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