The Teaching Point

The importance of radiological differential diagnostics of cervical dysfunction in children is still or more than ever controversial especially in manual medicine, which raises the question whether the requirement of x-ray-diagnostics prior to any manual manipulation treatment is necessary or not. With regard to the diagnosis of the spinal column valuable diagnostic information can be obtained by plain radiographs of the upper cervical spine. The indication for radiological diagnostics using computed tomography should be made carefully after consultation with the radiologist. The chosen case example from routine practice shows that a functional disorder of the upper cervical spine can be expression of extremely rare pathomorphological situation and that imaging diagnostic is essential in the clinical diagnostic setup.






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From the manuscript

Persistent proatlas with additional segmentation of the craniovertebral junction - The Tsuang-Goehmann-Malformation

Free full text article: Persistent proatlas with additional segmentation of the craniovertebral junction - The Tsuang-Goehmann-Malformation

Abstract
Case study description and analysis of a complex craniovertebral dysplasia in an 8-year-old male patient, in which conventional cervical spine radiographs demonstrated a regularly differentiated occipital base, as well as the presence of two lateral masses of the proatlas vertebra and two lateral masses of the atlas vertebra. Further assessment included computed tomography of the occipital base and the upper cervical spine as well as three-dimensional reconstruction. Malsegmentation of the fourth occipital vertebra can result in various anomalies that are known as `manifestation of the proatlas`. The occurrence of a persistent proatlas with additional segmentation of the craniovertebral junction represents an extremely rare dysplasia. To our knowledge, it is the second report concerning the persistence of a complete human proatlas vertebra. We consider the biomechanical and embryological particularities of this complex dysplasia to represent sufficient basis for future differentiation from other malformations of the fourth occipital vertebra. Comprehensive literature review and discussion about the entity will be provided.






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1. persistent proatlas

2. additional segmentation

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7. cervical spine

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