Accessory Articulation of the Transverse Processes in the Cervical Spine

Overview

Journal Radiol Case Rep

Publisher Elsevier

Specialty Radiology

Date 2022 May 19

PMID 35586168

Authors

Mayilone Sathialingam

Jonathan Lee

Tyler Ard

Vishal Patel

Affiliations

Soon will be listed here.

Abstract

Accessory articulation between the transverse processes of the C6 and C7 vertebrae is an extremely rare anatomic variant that has only been previously described in two instances. In this report, we present the case of a 25-year-old male who sustained numerous injuries associated with a physical assault. A CT study of the cervical spine revealed a linear lucency mimicking a fracture but found on closer inspection to represent an accessory articulation between the anterior tubercles of the right transverse processes of the C6 and C7 vertebrae. In this report, we summarize this patient's clinical course, and provide an up-to-date review of the current literature, imaging characteristics, and potential mechanisms of the development of this anatomic variant. Our case also includes an incomplete version of the anomaly contralaterally as well as features of secondary osseous stress hypertrophy; these features have not been previously described and may aid in diagnosis. Finally, we provide the first-ever augmented reality model of this variant to fully convey its geometry and facilitate its unequivocal identification.

References

Moffat M, Rosen E . Anatomical variations of the scalene triangle: dissection of 10 cadavers. J Orthop Sports Phys Ther. 2001; 31(2):70-80. DOI: 10.2519/jospt.2001.31.2.70. View

Nolte C, De Kumar B, Krumlauf R . Hox genes: Downstream "effectors" of retinoic acid signaling in vertebrate embryogenesis. Genesis. 2019; 57(7-8):e23306. DOI: 10.1002/dvg.23306. View

Mellado J, Larrosa R, Martin J, Yanguas N, Solanas S, Cozcolluela M . MDCT of variations and anomalies of the neural arch and its processes: part 2--articular processes, transverse processes, and high cervical spine. AJR Am J Roentgenol. 2011; 197(1):W114-21. DOI: 10.2214/AJR.10.5811. View

Chen F, Greer J, Capecchi M . Analysis of Hoxa7/Hoxb7 mutants suggests periodicity in the generation of the different sets of vertebrae. Mech Dev. 1998; 77(1):49-57. DOI: 10.1016/s0925-4773(98)00126-9. View

Wellik D . Hox genes and vertebrate axial pattern. Curr Top Dev Biol. 2009; 88:257-78. DOI: 10.1016/S0070-2153(09)88009-5. View

Hosking M, Warner M, Lobdell C, Offord K, Melton 3rd L . Outcomes of surgery in patients 90 years of age and older. JAMA. 1989; 261(13):1909-15. View

Bilreiro C, Saraiva J, Duarte Silva L, Brito J, Grande P . Accessory articulation of elongated anterior transverse process: a rare anatomical variant of the cervical spine depicted with CT and post-processing techniques. Surg Radiol Anat. 2015; 38(2):269-71. DOI: 10.1007/s00276-015-1535-3. View

Lufkin T, Dierich A, Lemeur M, Mark M, Chambon P . Disruption of the Hox-1.6 homeobox gene results in defects in a region corresponding to its rostral domain of expression. Cell. 1991; 66(6):1105-19. DOI: 10.1016/0092-8674(91)90034-v. View

Zhang X, Ma T, Liu L, Yin N, Zhao Z . Anatomic study of the musculus longus capitis flap. Surg Radiol Anat. 2016; 39(3):271-279. DOI: 10.1007/s00276-016-1708-8. View

10.

Kessel M, Balling R, Gruss P . Variations of cervical vertebrae after expression of a Hox-1.1 transgene in mice. Cell. 1990; 61(2):301-8. DOI: 10.1016/0092-8674(90)90810-2. View

11.

Lee J, Lee J, Lee H, Lee D, Lee D . The efficacy of carotid tubercle as an anatomical landmark for identification of cervical spinal level in the anterior cervical surgery: comparison with preoperative C-arm fluoroscopy. Clin Orthop Surg. 2013; 5(2):129-33. PMC: 3664672. DOI: 10.4055/cios.2013.5.2.129. View

12.

LAPAYOWKER M . An unusual variant of the cervical spine. Am J Roentgenol Radium Ther Nucl Med. 1960; 83:656-9. View

13.

Casaca A, Santos A, Mallo M . Controlling Hox gene expression and activity to build the vertebrate axial skeleton. Dev Dyn. 2013; 243(1):24-36. DOI: 10.1002/dvdy.24007. View

14.

Boyd-Clark L, Briggs C, Galea M . Muscle spindle distribution, morphology, and density in longus colli and multifidus muscles of the cervical spine. Spine (Phila Pa 1976). 2002; 27(7):694-701. DOI: 10.1097/00007632-200204010-00005. View

15.

Grilliot J, Wiles M . Elongation of the anterior tubercle of a cervical vertebral transverse process. J Manipulative Physiol Ther. 1988; 11(3):221-3. View

16.

Filly R, Simpson G, Linkowski G . Fetal spine morphology and maturation during the second trimester. Sonographic evaluation. J Ultrasound Med. 1987; 6(11):631-6. DOI: 10.7863/jum.1987.6.11.631. View

17.

Applbaum Y, Gerard P, Bryk D . Elongation of the anterior tubercle of a cervical vertebral transverse process: an unusual variant. Skeletal Radiol. 1983; 10(4):265-7. DOI: 10.1007/BF00357903. View

18.

Naidoo N, Khan N . Accessory articulation of the cervical vertebrae transverse processes simulating a fracture: Incidental findings of an uncommon anatomical variant. BJR Case Rep. 2022; 7(5):20210012. PMC: 8803249. DOI: 10.1259/bjrcr.20210012. View

19.

Unlu E, Buyukkaya A, Unlu I, Boran M, Gunes H . Elongation and aberrant articulation of cervical transverse processes mimicking osteochondroma. Spine J. 2015; 15(12):e55-6. DOI: 10.1016/j.spinee.2015.07.453. View

20.

Cha Y, Lee M, Yoon Y, Han J, Lim H, Jung I . Depth by ultrasound from skin surface to the C6 transverse process while applying pressure. Pain Med. 2011; 12(7):1026-31. DOI: 10.1111/j.1526-4637.2011.01171.x. View