What are the developmental defects of the cervical spine? What are the congenital anomalies of the cervical spine?

Developmental anomalies of the craniovertebral zone are represented by a unique group of dysplasias localized in the area of ​​the cranial-vertebral border and characterized by lesions nervous system of varying severity.

Features of clinical manifestations are determined by the specific type of anomaly and its topical location. A specific feature of these anomalies is their fairly frequent combination with anomalies in the development of the brain and skull. Characteristic feature Anomalies of the craniovertebral zone are also their long-term asymptomatic course and the manifestation of clinical manifestations in the late stages, in the stage of decompensation of the disease. Diagnosis of these dysplasias at an early age is significantly difficult due to compensatory capabilities child's body. It becomes possible to assume the presence of anomalies of the craniovertebral region in young children if the clinical picture shows neurological manifestations in the form of:

Cerebellar symptoms;

Syndrome of herniation of stem structures or cerebellar tonsils into the foramen magnum;

Circulatory disorders in the vertebrobasilar region;

Occlusal crises.

Anomalies in the development of the odontoid process

According to the literature, the frequency of this anomaly in the general population is 0.3 – 9.5%. the presence and severity of clinical symptoms depend on the type of anomaly in the development of the odontoid process. Of clinical interest is mainly the developmental anomaly of the axis in the form of a “dentate bone”, since other variants of this dysplasia occur without pronounced neurological disorders and are differentiated only during a radiological examination. however, in order to obtain a complete picture of the developmental anomaly of the odontoid process, it is advisable to provide radiological criteria for all currently known variants.

1) Hypoplasia of the odontoid process manifested by underdevelopment of the mass of the process and is radiographically characterized by a decrease in the anteroposterior size of the odontoid process in combination with normal development axis bodies; There are no clinical manifestations for this type of anomaly.

2) Hypertrophy of the odontoid process characterized by the presence of a massive odontoid process of the axis, the apex of which is located above the anterior tubercle of the atlas.

3) Aplasia of the odontoid process of the axis It is rare, diagnosed only by x-ray and is characterized by the absence of the odontoid process of the axis behind the anterior tuberosity of the atlas on a craniogram in a lateral projection. The picture is more demonstrative on a direct photograph through an open mouth or on a frontal tomogram.

4) Location of the odontoid process of the axis in the sagittal plane. If the tooth and the body of the axis are not fused, a “dentate bone” is formed. The frequency of this anomaly in the general population is 9.5% (Zadvornov Yu.N., 1979). This anomaly appears clinical symptoms from the nervous system (in the form of medullary compression) and the musculoskeletal system (chronic dynamic subluxation). Informative in diagnostic terms is the performance of functional radiographs, tomograms in lateral and frontal projections.

Assimilation of Atlanta

According to Khabirov F.A. (2001), this congenital anomaly of the craniovertebral zone occurs with a frequency in the general population of 0.4 - 2.16%. assimilation of the atlas is caused by pathological segmentation between the occipital bone of the skull and the upper cervical vertebrae. Several options for assimilation of the atlas are known - the articulation can be:

Partial;

Complex;

One-sided.

Also possible:

Concrescence of the atlas with the occipital bone, in which dislocation of the atlas is recorded with the introduction of the odontoid process of the axis into the spinal canal;

Assimilation of the atlas with the occipital bone is accompanied by the involvement of the occipital bone condyle in the process and unequal development of the articular processes.

When blocking the atlas:

To the base of the occipital bone in frontal plane underdevelopment of the odontoid process of the axis and the transverse ligament of the atlas is often recorded. Due to such a block and expansion of the Cruvelier joint, hypermobility and stenosis of the upper cervical segments occur spinal canal with compression of the spinal cord at the specified level;

To the anterior edge of the foramen magnum, conditions are created for the odontoid process of the axis to slide backward, which can also cause compression of the spinal cord in the upper cervical segment.

All patients with this pathology among patients with anomalies of the skull, brain and craniovertebral zone, as a rule, have phenotypic signs suggesting the presence of anomalies of the craniovertebral region:

Torticollis;

Shortened neck;

Incorrect head position;

Limitation of movements in the cervical-occipital segment;

Restriction of head movement from side to side.

If pathological segmentation is caused by a block of the posterior arch of the atlas with the posterior edge of the foramen magnum, then the notch of the vertebral artery is deformed with a subsequent decrease in the diameter of the lumen of the vessel and the occurrence of vasodynamic disorders.

In the case of unilateral atlas assimilation, clinical manifestations are caused by compression of the spinal cord substance due to rotation of the atlas. Patients complain of episodes of dizziness, a feeling of discomfort when working in an inclined position and turning the head. In most cases, when forming an anamnesis, information about injuries that preceded the appearance of complaints appears. An objective examination of such patients reveals a short neck, torticollis, and limited mobility in the cervical spine (head turns to the side). When the atlas is assimilated with the occipital bone, significant asymmetry of the occipital condyles is observed. The final diagnosis of patients with this anomaly can be made by X-ray examination. An image of the skull in a lateral projection reveals:

Block of the anterior tuberosity C1 with basion;

Expansion of the Cruvelier joint and subluxation of the atlas;

Absence of a facet on the posterior surface of the tuberosity of the atlas and the anterior surface of the odontoid process of C2;

Anterior arcuate curvature of C2;

Irregularity of the posteroinferior edge of the foramen magnum;

Hypoplasia of the odontoid process.

A photograph of the skull in the frontonasal projection reveals:

An increase in the height of one half of the atlas compared to the other;

Absence of joint space between the atlas and the condyle of the occipital bone;

Lower rear position cranial fossa from the block side.

In cases of assimilation of the posterior arch of the atlas with the arch of the axis, the most informative diagnostic method should be considered a radiography of the skull in a lateral projection and a sagittal tomogram. On the radiograph in in this case the posterior wall of the intraspinal canal is visualized, forming a continuous line with a convexity facing the vertebral bodies. It is possible to diagnose atlas assimilation in children only at the age of 9–13 years. The absence of gross clinical and neurological symptoms in pediatric patients is probably explained by the compensatory capabilities of the child’s body.

Platybasia

This anomaly of the development of the craniovertebral zone rarely occurs in the form of isolated dysplasia. In most cases, there is a combination of platybasia with basilar impression or other anomalies of the craniovertebral zone. The frequency of Platybasia in the general population is 25% (Zadvornov Yu.N., 1979). It is known that Platybasia is characterized by:

Flattening of the base of the skull;

Reduction of the anterior and posterior cranial fossae;

Shortening the slope;

The location of the slope in the horizontal plane.

The degree of platybasia correlates with the value of the Welker angle, which is formed by a straight line from the nasion to the tubercle of the sella turcica and from the basion to the tubercle of the sella turcica. The value of this indicator is determined angulometrically using lateral craniograms or tomograms. Its normal value is 135 degrees. Degrees of Platybasia:

I degree - diagnosed if the Welker angle is within 135 - 140 degrees;

II degree – diagnosed when the Welker angle is in the range of 145 - 160 degrees;

III degree – diagnosed when the Welker angle is more than 160 degrees. The clinical feature of this anomaly is its long-term, low-progressive course. There are cases when platybasia was not accompanied by pronounced changes in neurological status and was detected only during radiography of patients with cephalgia of unknown origin.

The value of the Welker angle is not the only indicator that allows us to differentiate platybasia. The presence of this pathology is also indicated by:

Relative reduction in the length of the slope;

The location of the odontoid process of the epistrophy (on the lateral radiograph) is 4–8 mm above the McGregor line;

Reducing the value of the Claus index to 32 - 38 mm (normally 40 - 52 mm).

Basilar impression

This anomaly in the development of the craniovertebral zone is an intracranial depression of the base of the skull into the cavity of the posterior cranial fossa. Basilar impression occurs in the population with a frequency of 1–2% and is one of the most studied anomalies of the craniovertebral zone. Basilar impression is based on underdevelopment of the edges of the foramen magnum (like hypoplasia or dysplasia). Depending on the location of the area of ​​underdevelopment, the forms of basilar impression are differentiated:

Front;

Paramedian;

Mixed.

It has been established that there is no direct correlation between the severity of bone abnormalities and the severity of the clinical and neurological picture. Since basilar impression often occurs in combination with other anomalies of the craniovertebral zone, an integrated approach should also be taken in studying the pathogenesis and characteristics of clinical manifestations. When assessing neurological manifestations, one should take into account not only the topical level and severity of dysplasia, it is also necessary to take into account the patient’s age, possible masking of the process by degenerative-dystrophic changes, the presence and severity of other dysplasias of the craniovertebral zone.

In the neurological status with basilar impression, brainstem, cerebellar, spinal, and radicular symptoms are observed against the background of intracranial hypertension. (Lobzin V.S. et al., 1988; Piovesan E.J et al., 1999; Tabuchi K., Shirai Shi t., 2000; Zotter H. et al., 2000). In childhood, this anomaly is practically not diagnosed due to its asymptomatic course. The long-term absence of clinical manifestations is explained by the unique compensatory capabilities of the child’s body (the presence of synchondrosis and inca bones).

Decompensation develops gradually, and the disease, as a rule, manifests itself at the age of 15–25 years with paroxysmal headaches, often of an occlusive nature, sometimes with a forced position of the head and vegetative manifestations. Patients complain of intense pain in the cervical occipital region, impaired tactile and temperature sensitivity in the extremities, unsteadiness when walking and loss of coordination, difficulty swallowing, double vision, hearing impairment, perceptual disturbances (pseudohallucinations).

Focal symptoms - nystagmus, hoarseness, difficulty swallowing, dynamic and static ataxia - indicate topically the level of damage in the brainstem and cerebellum. Often, the clinical picture is dominated by signs of damage to the cranial nerves (11–12 pairs), including bulbar symptoms, dissociative sensory disorders and syringomyelitic-type sensory disturbances, vestibulocochlear disorders, and circulatory disorders in the vertebrobasilar region.

When the spinal cord is compressed due to posterior displacement of the axis (due to inferiority of the transverse ligament or hypoplasia of the odontoid process of the axis), the following are noted in the neurological status: pyramidal disorders of varying severity (from slight hyperreflexia to severe tetraparesis) and liquorodynamic disorders. Ophthalmoscopically recorded congestion on the fundus; When examining the cerebrospinal fluid, protein-cell dissociation is revealed. Thus, there are manifestations similar to those with a tumor of the posterior cranial fossa. It becomes clear why patients with basilar impression in most cases were sent for an X-ray examination in order to exclude or confirm a tumor of the posterior cranial fossa.

In the presence of combined pathology - basilar impression and assimilation of the atlas - the neurological picture described above is accompanied by symptoms of high spinal compression with minor motor and sensory disturbances of the conduction type (segmentally dissociated in nature at the level of the lower cervical and thoracic dermatomes). Symptoms of brain stem damage (nystagmus, hearing loss, choking) are accompanied by intense headaches. Radiologically, basilar impression is determined by the protrusion of the epistrophic tooth:

Above the Chamberlain line by 6 – 30 mm;

Above the McGregor line by 8 - 32 mm;

Above the bimastoid line by 10 - 15 mm.

The value of the main angle is within 120 - 140 degrees. The final criteria for making a diagnosis are the result x-ray examination, data from magnetic resonance imaging, computed tomography. Informative diagnostic methods for basilar impression are:

Survey craniospondylograms performed in frontal and lateral projections;

Shot through an open mouth;

Tomograms with functional tests.

Radiologically, the following criteria for basilar impression are recorded in patients with this anomaly:

Change in skull configuration;

Thinning of the bones of the cranial vault;

Signs of intracranial hypertension (increased digital impressions);

Changing the shape and structure of the back of the sella turcica (straightening and thinning);

High standing pyramids;

Variants of the structure and development of the scales of the occipital bone (worm bone);

The height of the odontoid process of the epistropheus is above the McGregor line;

Shortening of the Mlumenbach clivus and its deformation;

Decrease in Claus index;

Increasing the Welker angle;

The Thibault-Wackenheim line does not pass through the odontoid process, but through the body of the axis, leaving behind the entire odontoid process.

It should be emphasized that based on determining the location of structures relative to McGregor's line and Welker's value, it is possible to diagnose basilar impression not only in adults. but also in children. On craniograms in the frontonasal projection with basilar impression:

The apex of the odontoid process is located significantly above the bimastoid line (Fischgold-Metzger line);

The biventral line does not correspond to the base of the posterior cranial fossa;

The vestibular line (Wackenheim line) is located obliquely. A more detailed study of bone deformations of the craniovertebral zone is possible using X-ray computed tomography (CT) with functional tests.

Kimmerle anomaly

According to literature data (Lutsik A.A., 1981), Kimmerle’s anomaly occurs with a frequency of 12–15.5% in the general population. Kimmerle's anomaly, like most other anomalies of the craniovertebral zone, is rarely noted in isolation. More often there is a combination of this anomaly with other dysplasias of the craniovertebral region (with basilar impression, with assimilation of the atlas). Kimmerle's anomaly is a phenomenon that is caused by the presence of an abnormal bony ring around the vertebral artery and the posterior bridge of the atlas (here ossification of the atlantooccipital canal occurs, and the groove turns into the canal of the vertebral artery), which significantly limit the mobility of the vertebral artery. The artery, fixed in the bone ring, is subject to compression by adjacent tissue structures and the foramen magnum during retroflexion of the head. For a long time, this anomaly can be asymptomatic. The manifestation of clinical manifestations can be initiated by:

Microtraumatization of the vascular wall with subsequent development of a chronic inflammatory process;

Atherosclerotic changes;

Vasculitis;

Scar processes;

Injuries cervical spine spine.

Stenosis, leading to vertebrobasilar vascular insufficiency, causes the appearance of neurological symptoms (headaches in the cervico-occipital region, neck pain, cochleovestibular disorders, visual disturbances, transient decrease in visual acuity, ataxia).

In the clinical picture in patients with this anomaly of the craniovertebral zone, symptoms of circulatory disorders in the vertebrobasilar region prevail, as well as manifestations of early-onset dystrophic-degenerative changes in the tissues of the cervical spine involving vertebral arteries, followed by their stenosis and sclerosis.

Klippel-Feil anomaly (synostosis of the cervical vertebrae)

The frequency of this anomaly is not high and amounts to 0.2 – 0.8% in the general population. Its study is associated with the name of M. Klippel and A. Feil (1912), who observed a patient with a reduced number of cervical vertebrae fused into one conglomerate. With Klippel-Feil anomaly, there is a fusion of the cervical and, less commonly, thoracic vertebrae into a single structure, with a decrease in the size of the intervertebral foramina in combination with high scapulae (Sprengel's symptom), cleft hard palate, polydactyly. asymmetry facial skeleton, with the presence of wedge-shaped vertebrae, accessory sacrolumbar vertebrae, developmental defects internal organs. There are few clinical observations of such cases, which, as already mentioned, is explained by the low frequency of this phenomenon in the general population. The literature describes cases of hereditary synostosis observed in members of the same family over several generations; The role of genetic determination of the anomaly is discussed. With Klippel-Feil anomaly, clinical manifestations are observed from 10 to 12 years of age. The early manifestation of symptoms is explained by a significant narrowing of the foramen magnum and the spinal canal due to rotational displacement of the vertebrae, and the rapid development of degenerative changes in the tissues of the cervical spine due to functional overload of the segments. adjacent to synostotic vertebrae. This pathogenetic substrate determines the clinical and neurological features of the Klippel-Feil anomaly. The clinical picture of Klippel-Feil anomaly is dominated by symptoms of spinal cord damage involving the conduction and segmental systems and pain radicular syndrome. The following clinical signs of this anomaly are noteworthy:

Intense but not constant headaches of a hypertensive nature without clear localization, which may be accompanied by syncope with loss of consciousness and episodes of apnea;

Bulbar symptoms;

Pyramid signs;

Cerebellar disorders;

Sensory impairment in the hands of the radicular type.

It should be emphasized that the pathogenesis of neurological manifestations is due to impaired blood circulation in the vertebrobasilar region due to compression of the radiculomedullary and vertebral arteries by bone formations with the subsequent development of sclerotic changes in the corresponding vessels. X-rays reveal synostotic upper cervical vertebrae in combination with assimilation of the atlas and basilar impression.

Elongated styloid process syndrome (stylohyoid syndrome)

According to literature data (Korchansky I.I., 1987), the representation of this phenomenon in the population is 4%. This syndrome was first described by H. Ergle in 1937. The phenomenon is caused by the elongation of the styloid processes and is manifested clinically by headaches predominantly of the temporal localization, pain in the neck, increasing with turns, etc. head tilts; raising and lowering the shoulders, difficulty swallowing (dysphagia). The clinical picture shows symptoms of focal brain damage in the carotid and/or vertebrobasilar areas. There are two variants of this syndrome:

Actually stylohyoid syndrome;

Syndrome of compression of the carotid artery by the elongated styloid process.

Manifestation of the main part of the occipital bone

According to literature data, the frequency of this phenomenon in the population is 0.3 – 1%. Rudimentary elements of bone tissue in the occipital region (the so-called occipital vertebra) are formed in the early embryonic period. This occurs if the connective tissue cord that forms on the ventral side of the vertebral bodies during ontogenesis is not subsequently reduced. On craniograms performed in the main projections, during X-ray CT, as well as on sagittal and frontal tomograms, structures and inclusions of bone density located in the extracranial part of the foramen magnum or within its anterior, posterior, and lateral edges are revealed. There are several forms of the proatlas, depending on its location and articulation with the base of the skull:

Free proatlas - fusion between rudimentary bone tissue and adjacent bone formations (basion, upper edge of the anterior tuberosity of the atlas) is absent;

“third condyle” (or processus basilaris) – fusion of rudimentary bone tissue with the exocranial part of the anterior edge of the foramen magnum with the formation of a bone growth located in the sagittal plane (this formation is clearly visualized on craniograms in a lateral projection);

The paraoccipital process (rudiment of the posterior arch of the proatlas) is the fusion of rudimentary bone tissue with the exocranial part of the lower edge of the foramen magnum with the formation of a bone growth, differentiated on craniograms in the lateral projection.

The large size of this formation causes the development of clinical manifestations, mainly movement disorders. Movement disorders of varying severity also arise when the anterior proatlas merges with the upper edge of the anterior tuberosity of the atlas. In the event that there has been intrauterine damage to the connective tissue cord, the appearance of ugly bone inclusions fused with the vertebral bodies or the formation of a syndesmosis between normal and rudimentary vertebrae is possible. To diagnose these anomalies, it is recommended to:

Craniogram in main projections;

Sagittal and frontal tomograms of the skull and craniovertebral border;

RCT with three-dimensional image.

Depending on the type of dysplasia, the following may also be informative:

Frontonasal image;

Axial view of the base of the skull.

Hypoplasia of the posterior arch of the atlas

Hypoplasia of the posterior arch of the atlas is detected in the population with a frequency of 5–9% (Klaus E., 1969). Underdevelopment of the posterior arch of the atlas, manifested by non-fusion of its lateral mass, also refers to anomalies of the craniovertebral zone. This anomaly is rare, occurs without clinical manifestations and is diagnosed as an incidental finding during radiography prescribed for injury or other disease. Radiological criteria for some variants of hypoplasia of the posterior arch of the atlas:

Non-fusion of the lateral mass of the atlas - manifested by the presence of vertical cracks 1 - 2 mm wide at the level of fusion of the lateral mass of the atlas with the posterior part of the arch;

Nonfusion of the posterior arch C1 - manifested by the absence of the bone wall of the intraspinal canal, the blind separated end of the dorsal parts of both arches; in this case, the posterior tubercle of the atlas is practically absent;

Hypoplasia of the posterior arch C1 - manifested by underdevelopment of the posterior arch, which ends with a reduced posterior tuberosity of the atlas;

Hypoplasia of the posterior arch of C2 is manifested by a noticeable decrease in the size of the spinous process of the axis compared to the size of the posterior tuberosity of the atlas (normally, the spinous process of the axis should be larger than the posterior tuberosity of the atlas).

Aplasia of the posterior arch of the atlas

Aplasia of the posterior arch of the atlas occurs with a frequency of 0.5 - 10% (Torklus, 1975). This anomaly indicates the absence of the posterior arch of the atlas, underdevelopment of the cruciate ligament. Clinical manifestations observed in childhood and adolescence. Symptoms increase rapidly, which is associated with compression of the distal part of the medulla oblongata and proximal part of the spinal cord. Patients complain of intense headaches. Upon examination, notice a significant degree of extension of the head anteriorly. On the craniogram in the lateral projection, the absence of the posterior arch of the atlas is noted, the anterior tubercle and lateral mass of the atlas are clearly visible, with the preservation of the platform for articulation with the condyle of the occipital bone.

The assimilation of the atlas consists of its lateral masses or arches being partially or completely fused with the occipital bone. There are: 1) assimilation of the atlas in the form of a semi-atlas, when the lateral mass and transverse process are attached to the occipital bone; 2) complete fusion of the lateral masses of the atlas without transverse processes; 3) growth of the anterior and partially posterior arch of the atlas; 4) fusion of the articular sections and half of the atlas.

Manifestation of pro-Atlas

The manifestation of the proatlas was first described by anatomists as an additional bone formation originating from the edges of the foramen magnum. The morphological picture of this developmental anomaly has many variations. The most characteristic feature is the appearance of bone ridges united into one process along the anterior surface of the foramen magnum. Manifestation of the proatlas can be manifested by slight compaction of the posterior edge of the foramen magnum, as well as the presence of individual ossicles in the projection of the posterior or anterior atlanto-occipital membrane.

Cervical ribs or hyperplasia of the costotransverse processes

The cervical ribs originate from the rib primordium of the VII cervical vertebra. IN embryonic period The development of the costotransverse processes has different timing. First, the process of ossification involves the rudiment of the transverse process, which is located dorsally. The ventrally located rib primordium undergoes bone degeneration much later, due to which, if synostosis is disturbed, it can develop independently and manifest itself as a separate bone formation. Cervical ribs are formed in 0.5-1.5% of patients (according to V.A. Dyachenko, 1954), and according to V.S. Maykova-Stroganova and M.A. Finkelstein (1952) - in 7% of patients. Cervical ribs and hyperplasia of the costotransverse processes in our studies occurred in 21.68% of patients.

Many authors associate pain in the cervicothoracic junction and glenohumeral periarthrosis syndrome with asymmetric development of the cervical ribs. At the same time, it is impossible to speak unequivocally about the etiological significance of the cervical ribs in the occurrence of glenohumeral periarthrosis syndrome. The clinical picture usually develops in adults who have this development option for 30-40 years. There is no correlation between the severity of the cervical ribs and pain. In almost all cases of glenohumeral periarthrosis, the cervical ribs have no large size. I.L. Tager and V.A. Dyachenko (1971) suggest that the presence of a clinical picture can be associated primarily with dystrophic changes developing in the cervical spine. On the other hand, they do not exclude the early occurrence of these dystrophic changes due to the limited statics of the cervical vertebrae, which is due to the stabilization of the VII vertebra by the cervical ribs.

There are many reasons for its formation - from congenital anomalies to post-traumatic blocking. The detection rate is 1 case per several tens of thousands of the population, however, medical workers are concerned about the annual increase in pathology.

Option of norm and abnormality

Concrescence may be one of the normal variants. For example, during fusion of pelvic structures. Whereas synostosis that forms in the vertebral elements is only a pathological condition.

The physiological variant of bone fusion occurs in a person during his growing up period. At this moment, cartilage tissue, due to natural characteristics, is gradually replaced by bone. These processes occur in all structures of the human skeleton - both in the sacral elements and in the bones of the skull.

Along with the physiological concrescence described above, a congenital anomaly may also be observed - due to hypoplasia or aplasia of intervertebral tissue. Root cause and provoking factors such deviation in the development of the spinal column, experts have not yet definitively established. The majority is of the opinion that this is a genetically determined pathology. The baby is already getting mutant gene from one of the parents, or from both.

Concrescence of the cervical vertebrae

Stages of development of concrescence

Blocking - concrescence of the vertebrae - occurs in a child at a very early stage of its formation. Experts consider it as a delay in the baby’s development. Complete diagnostics at the prenatal stage is either not carried out or is not performed in full.

Directly depending on the time period of occurrence of pathological blocks in the spinal column, they are divided into 3 main stages:

• Pathology formed before the 15th–20th week of pregnancy.
• Blocks detected in utero in a baby after 25–30 weeks of pregnancy.
• Diagnosis of abnormalities after the birth of a child.

Particular importance is attached to the early detection of fetal growth arrest. Already by 5–7 weeks of pregnancy, it is possible to reliably determine that the intervertebral discs have practically formed, and there is even a physiological separation of the posterior vertebral structures. But in the case of concrescence, the anterior parts of the fetal spine remain a fused conglomerate.

Causes of pathology

Among the terratogenic factors that can provoke anomalies of musculoskeletal structures at the intrauterine stage of their formation, experts highlight:

• various infectious pathologies suffered by a pregnant woman;
• negative hereditary predisposition;
• traumatization;
• pathological effects of radiation.

This disease is most often inherited

A combination of synostosis with other chromosomal pathologies is often observed. For example, blocking vertebral elements in cervical region, in more than half of the identified cases is combined with pathological splitting of their arches. The presence of an accessory vertebra or atlas anomaly may be diagnosed.

Symptoms of concrescence

If a pathology is detected in a child at a late stage of its occurrence - after he is born, warning signs should be that the spine is too short and their mobility is limited.

The specialist makes a preliminary diagnosis based on a set of symptoms:

• non-standard, asymmetrical neck shape;
• extremely low hairline;
• the location of the skull is literally immediately after the shoulders;
• significantly narrowed glottis.

Often, blocking of the vertebral elements is accompanied by abnormal formation of the scapular bones. Visually, they are located much higher than the usual location. The base of the skull seems to be depressed.

With this pathology, a low head position is visually noticeable.

Nervous structures also suffer significantly in this pathology - they simply cannot, due to their location, fully function. Patients develop disorders of the sensitive perception of the skin. It is very difficult for them to carry out motor activity in the spine and move their limbs.

This type of pathology in the vertebral elements leads to disruption of the functioning of internal organs, which further aggravates people’s well-being. The final diagnosis is made only after a comprehensive examination using hardware and laboratory methods.

Diagnosis of pathology

Today, modern equipment provides significant assistance to specialists in making an adequate diagnosis:

• CT scan – allows you to examine sections of bone tissue in transverse as well as longitudinal projection, distinctive features: high accuracy and relatively wide availability in medical institutions;
• MRI – in the images you can see not only the localization, but also the area of ​​pathological modifications, study them thoroughly, and reveal in detail the type of pathology;
• Radiography is the most widely used diagnostic method; anomalies in the structure of the vertebrae and their damage are clearly visible in the images, which makes it possible to clarify the area of ​​study for other hardware methods.

Only the completeness of the information obtained after carrying out the above diagnostic procedures allows a specialist to conduct an adequate differential diagnosis.

Treatment of vertebral concrescence

• post-isometric relaxation of muscle groups;
• various methods of physiotherapy;
• paraffin applications;
• exercise therapy complexes;
• individual or group yoga classes.

It is necessary to perform special gymnastics every day

It is almost impossible to do anything for the vertebral structures affected by the disease. The main goal of treatment procedures is to help muscle groups. The emphasis must be placed not only on the affected area of ​​the spine, but also on neighboring sections too. You should not expect quick results - treatment is carried out throughout the patient’s life.

Practiced and symptomatic therapy, during the period of exacerbation of the pain syndrome, medications from the subgroups of analgesics and anti-inflammatory drugs are prescribed. Based on individual indications, the issue of surgical treatment concrescence.

Complete and partial vertebral concrescence - causes and treatment options

Orthopedist: I say for the hundredth time, do not apply ointments and do not inject chemicals into your sore BACK and JOINTS.

Vertebral concrescence belongs to a group of congenital vertebral pathologies that have a negative impact on the functionality of the spine and general health. If a woman is regularly seen by specialists during pregnancy, this defect can be diagnosed early - already at 20 weeks of pregnancy. The disease does not respond well to treatment, but it must be carried out constantly in order to alleviate suffering and improve the patient’s quality of life.

Description

Vertebral concrescence is the fusion of bone structures with each other. This phenomenon is considered one of the normal variants for pelvic structures, but for the vertebrae of the thoracic and cervical spine it is considered a pathology. It is formed as a result of aplasia or hypoplasia of bone tissue. The disease is considered rare, occurring in one person in tens of thousands. However, in recent years Doctors report an increase in the number of patients with this pathology.

By its type, concrescence can be:

• Incomplete. With it, only the fusion of the vertebral bodies themselves is observed.
• Full. The lateral processes of the affected vertebrae are also involved in this process.

The pathology most often affects the cervical spine. This form is called Klippel-Feil disease. It has two main development options:

• Fusion of the first vertebra with the cranial occipital bone.
• Fusion of the first and second vertebrae. Sometimes vertebrae c3 c4 may join them. It is extremely rare that the disease affects other structures of the cervical spine. But never more than 4 vertebrae are involved in this process.

The disease is accompanied intense pain. The patient's motor functions are impaired, significantly limited in volume, any physical efforts and loads cause painful attacks. If the disease is congenital, scoliosis, lordosis or other types of spinal curvature develop over time.

Over time, pain and crunching in the back and joints can lead to dire consequences - local or complete restriction of movements in the joint and spine, even to the point of disability. People, taught by bitter experience, use natural remedy, which is recommended by orthopedist Bubnovsky. Read more"

Reasons

Fusion of the thoracic or cervical vertebrae can be caused by the following factors:

• Anomalies intrauterine development fetus May be caused by hereditary factors transmitted by the mother during pregnancy infectious diseases, exposure of the fetus to radiation. Often the disease is combined with other chromosomal pathologies. More often, in children with such pathologies, fusion of the c2 c3 vertebrae is observed.
• In adults, concrescence is formed due to past diseases, in particular, ankylosing spondylitis and other joint pathologies.
• Post-traumatic consequences. Fusion of the vertebrae can occur after damage to the cartilage or periosteum. Pathology can also appear after dislocation of the vertebral body or fracture of the marginal parts of its body.

However, scientists believe that the main cause of concrescence is genetic abnormalities.

Symptoms

Complete or incomplete concrescence of the vertebrae can be determined by a number of symptoms. Among them:

• Limited mobility of the spine, their insufficient length. This symptom can be diagnosed immediately after birth.
• Deviations in the functioning of the nervous system. The patient may experience disturbances in the sensitivity of the skin. They often have difficulty at work lower limbs, it’s hard for them to walk.
• Disruption of internal organs. Can suffer from vertebral fusion various systems, including circulatory, digestive and others.
• Frequent headaches. They are observed in patients suffering from fusion of the vertebrae c5, c6, as well as c1 and c2.

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Also, fusion of the cervical vertebrae is indicated by a too short neck, low hairline, or narrowed glottis. People with this pathology can be distinguished by the special position of the skull - their head seems to be pressed into their shoulders.

Diagnostics

If fusion of the vertebral bodies is suspected, the patient is prescribed comprehensive diagnostics, providing:

• General examination of the patient, history taking. Makes it possible to establish the probable causes of the development of pathology and determine the range of further studies.
• Radiography. Allows you to track pathological changes in the vertebrae and accurately determine the affected area.
• MRI. Used to study the degree of damage to the vertebrae. Allows you to accurately determine not only the location of the pathology, but also its type.
• CT. Makes it possible to obtain sections of bone tissue in various projections. It is the most common and popular type of diagnosis used for fusion of vertebral bodies.

Full diagnostics is carried out for children and adults. At the stage of embryonic development, diagnosis is made based on ultrasound of the fetus.

Install accurate diagnosis, it is possible to determine treatment tactics only based on an analysis of research results.

Treatment

Most patients with concretion are prescribed treatment aimed at correcting defects in the muscle groups and tissues surrounding the affected vertebrae. Therapy in the early stages of identifying the disease includes:

• paraffin applications;
• physical therapy complexes;
• yoga classes (they need to be selected taking into account the condition of the spine, the location of the pathology, and the general condition of muscle groups);
• post-isometric muscle relaxation;
• wearing special collars (used only during the period of active growth of the child);
• complexes of physiotherapeutic procedures.

During exacerbation of pain, analgesics and non-steroidal anti-inflammatory drugs are prescribed.

In rare cases, surgical intervention is indicated. The operation involves removing part of the pathological structures. After the operation, the patient undergoes rehabilitation therapy for a long time and can be sent to health resort treatment.

The prognosis for fusion of the lumbar, thoracic or cervical vertebrae is usually unfavorable. The patient must continue treatment until the end of his life. However, when making the right choice conservative therapy and following all medical instructions, it is possible to significantly increase motor and functional capabilities.

Complications

Partial and complete concrescence leads to the development of various pathological conditions. Among them:

• paralysis;
• fusion of a vertebra of one section with vertebrae of another section (for example, fusion of the lumbar and sacral vertebrae);
• Sprengel's disease (high scapula);
• frequent prolonged migraines developing against the background of fusion of the vertebrae c1 c2 or c6 c7;
• osteochondrosis;
• disturbances in the functioning of the heart muscle;
• malfunctions digestive organs, respiratory organs;
• deformation of the feet, formation of additional toes;
• hypoplasia;
• scoliosis.

These pathologies can be congenital (if the fusion of the vertebrae was formed during intrauterine development) or acquired (with secondary fusion of bone tissue) in nature. All of them require correction. The scope of medical care is determined by the severity of the patient's condition.

Diagnosis and treatment of vertebral concrescence (blocking)

Cervical vertebrae concretion or fusion (locking) is a very rare condition. The pathology affects one person from. In most cases, the disease is hereditary and congenital.

Vertebral concrescence is considered to be one of the types of spinal column anomalies. This term is popularly called blocking or fusion of vertebrae with each other. Often the pathology is congenital, but sometimes there are cases of secondary concrescence. When the cervical spine is affected, they speak of the development of Klippel-Feil syndrome. According to medical statistics the pathology affects one person.

Photograph of a patient with vertebral concrescence syndrome. This pathology is congenital and very rare.

Description of the disease

The essence of concrescence is that the bodies of adjacent vertebrae are fused with the spine. With complete synostoses, not only the bodies are blocked, the processes and arches of the vertebrae undergo fusion. In this case, the spinal column is not deformed. Partial concrescence does not completely affect the structural elements of the spine.

There are two types of cervical vertebral fusion syndrome:

• Blocking of the first and second cervical vertebrae. This deviation is characterized by unfused arches.
• Fusion of the atlas and occipital bone. In patients with this pathology, the height of the spinal column is below normal.

Important! Sometimes there are cases of fusion of the arches and processes of the vertebrae with adjacent bones, for example, with the ribs.

Concrescence of the vertebrae in most cases is a congenital pathology. It is associated with impaired segmentation in the prenatal period, hypoplasia, and aplasia. Often, abnormal development of vertebrae is caused by defects in chromosomes.

Vertebral fusion can be of several types. The most common is short neck syndrome.

Signs of anomaly

Concrescence is determined by the presence of the following manifestations:

• low hairline in the occipital region;
• shortening of the neck;
• minor developmental anomalies (“high shoulder blades”, insufficient number of vertebrae, folds in the form of “wings” on the neck, etc.);
• limited neck mobility;
• pain in the neck and head;
• neuralgic disorders.

Note: Due to the obvious manifestation of the pathology - shortening of the neck, Klippel-Feil syndrome is called short neck syndrome.

Klippel-Feil syndrome is usually diagnosed in newborns. The likelihood of developing a disease in a fetus during intrauterine development can be determined using medical genetic studies.

Diagnostic and treatment methods

Spinal fusion is usually diagnosed during the first examination by a specialist. To confirm the diagnosis, the patient undergoes ultrasound, radiography, MRI, rheoencephalography, genetic research, and electrocardiogram.

The fusion of the vertebrae is visible to the naked eye; to clarify the diagnosis, the doctor sends the patient to undergo some tests.

Treatment of this pathology includes a set of measures aimed at relieving pain, restoring intracranial pressure, relieving muscle tone in the neck and increasing spinal mobility. Patients suffering from vertebral concrescence are prescribed:

• taking medications (antibiotics, painkillers and other drugs);
• massage sessions;
• conducting therapeutic exercises;
• acupuncture;
• osteopathy and other physiotherapeutic procedures.

In cases of exacerbation, the patient is advised to wear a Shants collar. Seriously ill patients are offered surgical treatment- removal of incorrectly located upper ribs, abnormal vertebrae in the lumbar or sacral area. The purpose of the operation is to lengthen the neck and restore mobility of the spine.

Unfortunately, it is impossible to completely cure the disease. With an integrated treatment approach, there is a chance to improve the patient’s condition and slow down the abnormal development of the pathology.

Patients with short neck syndrome are recommended to wear a Chance collar during an exacerbation.

Consequences and complications

Concrescence of the vertebrae is usually accompanied by a number of complications, the most common being:

• paralysis;
• scoliosis;
• heart pathologies;
• foot deformity;
• osteochondrosis;
• torticollis;
• the presence of additional fingers;
• sacralization or lumbalization;
• Sprengel's disease;
• hypoplasia, etc.

In rare cases, patients with vertebral concrescence are prescribed surgical treatment. Surgery is indicated when the patient is in severe pain and medications do not help.

It is impossible to prevent the development of the disease, since in most cases the pathology is inherited. Families who have ever encountered such an anomaly are recommended to undergo genetic testing to determine the likelihood of having a baby with pathology of vertebral fusion.

The information on the site is for informational purposes only. Before starting treatment, we recommend consulting a specialist

Complete concrescence of C2-C3?

Good day. Woman born 1982

1 and osteozondrosis 2 tbsp.

Thank you! What could be above the spinous process of C1?

Sesamoid bone. Pro-Atlas variant.

Did you come with a migraine?

Thank you! What could be above the spinous process of C1?

As far as I remember, C1 does not have a spinous process.

Sincerely. Ilyich.

And osteozondrosis 2 tbsp.

And osteozondrosis 2 tbsp.

What, are there approved stages of osteochondrosis? Which ones and by whom?

And osteozondrosis 2 tbsp.

What, are there approved stages of osteochondrosis? Which ones and by whom?

And osteozondrosis 2 tbsp.

What, are there approved stages of osteochondrosis? Which ones and by whom?

I don’t know how good THIS is, but nothing else was found

But you read what kind of discussion unfolded there.

“Listen to everyone, listen to a few, decide for yourself.”©

The last one doesn't open. As I understand it, no one has approved the official division of osteochondrosis into stages or degrees. But for general development not bad for “read”.

The last one doesn't open.

Corrected it. I checked. Now working

“Listen to everyone, listen to a few, decide for yourself.”©

And osteozondrosis 2 tbsp.

What, are there approved stages of osteochondrosis? Which ones and by whom?

By me!👀 Is there a narrowing? Eat! But not expressed, at least 1/2! Are there pronounced anterior coracoid osteophytes? Eat! It remains to check the instability in this PDS.

And osteozondrosis 2 tbsp.

What, are there approved stages of osteochondrosis? Which ones and by whom?

Here. Another find. Bourgeois-translated (pictures at the end of the article). Maybe someone will find it useful

Natalya Ivanovna! We need to love our homeland more. See Article 66 on conscription in the Republic of Belarus. There are clearly stated 4 stages of OH!

Although Andrei Yurievich is right, this is how the stages of gray hair on the head can be broken down. Type: 1st grade - light gray hair, 2nd grade - gray hair, 3rd grade - completely gray and 4th grade - even with a bald head!)))

We need to love our homeland more. See Article 66 on conscription in the Republic of Belarus. There are clearly stated 4 stages of OH!

According to this document, they are in the Belarusian stage, and in the Russian Federation - fuk (suitable only for educational purposes))) Don’t poke your nose into someone else’s monastery with your own charter.

“Listen to everyone, listen to a few, decide for yourself.”©

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When reprinting materials, it is necessary to indicate the author's name and a link to the source.

How to treat vertebral fusion and why the pathology is dangerous

Vertebral fusion, or concrescence, is one of the most serious illnesses spine. Let's consider what the essence of the disease is and how it is treated.

Varieties

Blocking or fusion of vertebrae is considered a congenital pathology of the spine. There are two forms - partial and complete. When a complete block is formed, not only the processes, but also the vertebral bodies are connected.

When the spinous processes of the cervical vertebrae undergo fusion, Klippel-Feil syndrome is observed, which includes two types of fusion:

• Connection between the I (atlas) and II (epistropheus) cervical vertebrae. Very rarely affects the fragments below. There can be no more than 4 fused vertebrae.
• Connection of the atlas with the occipital bone.

Sacralization is a congenital anomaly of the lumbar vertebrae. In this case, the fifth vertebra moves from the lumbar to the sacral. A fairly common disease, more common in men. Lyubmalization, in contrast to sacralization, consists of the transition of the upper vertebra of the sacrum to the lumbar region.

There is also ankylosing spondylitis (ankylosing spondylitis), which involves inflammation of the intervertebral discs, which causes immobility of the spinal column. This disease Mostly young men are affected. Factors in the development of ankylosing spondylitis:

• genetic disorders;
• persistent infections of the intestines and genitourinary system;
• stress;
• damage to the musculoskeletal system.

Diagnostic methods

When disorders occur in the spine, the most important task is to make a timely diagnosis. It is advisable to consult a specialist if you have the following symptoms:

• pain in the sacrum area that intensifies at night, radiating to the buttocks and lower extremities;
• pain and compression in the thoracic region.

With ankylosing spondylitis, the symptoms are somewhat different:

• pain is felt mainly during rest and rest;
• spinal stiffness;
• you can feel tension in your back muscles (this is dangerous due to their gradual atrophy).

In the future, mobility is increasingly limited, pain is felt when bending over, sneezing and deep breathing. Pain decreases with physical activity of the spine, but increases with rest and inactivity.

With sacralization there are no pronounced symptoms. The pain in the lower back is almost not noticeable. This disease is dangerous because it can lead to osteochondrosis or spondyloarthrosis.

The main way to detect sacralization is radiography. In the image you can observe partial or complete connection of the vertebral bodies. To identify a pathological disorder of the transitional vertebra, it is necessary to count them in the sacral and lumbar region.

Treatment measures

In case of congenital pathology, physical therapy is regularly performed from an early age to ensure maximum mobility of the cervical or other parts of the spine. If the disease is serious, corrective exercises are prescribed or a special collar is applied.

When sacralization occurs without acute pathology, a complex of conservative treatment is carried out:

Attention! Medicines can only be prescribed by the attending physician; prescribing treatment on your own is strictly prohibited.

If ankylosing spondylitis is detected, in addition to the indicated methods, manual therapy is prescribed. Essential condition– the sick person must master the technique of muscle relaxation.

At unbearable pain and disruption of normal life, surgical intervention is performed. The method involves separating the vertebrae and replacing intervertebral discs with grafts.

Complications

When the thoracic and cervical vertebrae fuse after skeletal growth stops, degenerative changes occur in the spinal discs and scoliosis progresses. These changes cause malfunction of internal organs, especially the heart and lungs.

Sacralization causes depletion of the bone tissue of the vertebrae located above. As a result, pain increases.

Absolute cure of the disease is possible with surgical intervention, which is resorted to in extreme cases. Lyubmalization and sacralization are some of the causes of spinal curvature and severe pain in the lower back and sacrum.

Fusion of the cervical vertebrae C2 and C3 is the most common variant of the pathological connection, which also carries a high risk of complications.

Prevention

If a diagnosis of vertebral fusion has been made, undergo regular examination by specialists in this field (orthopedist, neurologist, vertebrologist). In case of loss of consciousness, severe pain If you experience nausea, consult your doctor immediately, as these disorders indicate the onset of complications.

Doctors recommend doing therapeutic exercises for the neck every day to keep it in good shape. To stop the progression of vertebral fusion, swimming, skiing, and sleeping on a hard bed without a pillow are recommended.

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Blocking of vertebrae (concrescence)

Blocking of vertebrae and concrescence are terms that designate one of the extremely severe pathologies of the spinal column, the essence of which is the fusion of adjacent vertebrae with each other.

The pathology may be congenital, in which case the vertebrae are not separated as a result abnormal development; sometimes a secondary concrescence occurs, which develops as a result of ankylosing spondylitis, post-traumatic spondylosis or other diseases.

What types of concrescence are there?

In the most severe cases (the so-called complete block), both the bodies and structures of the vertebrae are fused.

If the spine is affected at the level of the neck, experts call similar condition Klippel-Feil syndrome. In turn, this syndrome can also be divided into various types; Thus, with pathology of the first type, the first and second vertebrae fuse. Very rarely, the vertebrae that are located below fall into the fusion zone, but usually there are no more than four of them. This pathology is also combined with another deviation - unfused vertebral arches.

The second type of Klippel-Feil syndrome manifests itself as a fusion of the occipital bone and the first vertebra. The height of the spinal column in such patients is less than normal. Klippel-Feil syndrome is recorded very rarely and is detected in one out of 120 thousand children.

Signs of concrescence

As a rule, a specialist identifies a set of symptoms. Against the background of a short neck, the hairline appears very low. The child has difficulty turning his neck. The neck itself may have a non-standard asymmetrical shape. The glottis narrows.

Often the blocking of the vertebrae is accompanied by improper development of the scapula bone; visually it is located above its usual location. The base of the skull appears depressed. Some vertebrae may be defective.

It is quite logical that with this pathology they cannot function normally. nerve structures. The patient has problems with skin sensitivity; it is difficult for him to move his limbs and move his torso. In the cervical region, decreased muscle excitability is observed. The eyeballs may twitch characteristically (called nystagmus).

The final diagnosis can be made after an X-ray examination.

Treatment of concrescence

Unfortunately, there are no favorable prognoses for this pathology. Patients suffering from blocked vertebrae experience a number of serious problems even in basic activities and are incapacitated. Children are advised to do special gymnastics, since the exercises make the cervical region more mobile. Also, during periods of exacerbation, a Shants collar is worn.

Symptomatic treatment is practiced: analgesics are taken to relieve pain, and in some cases anti-inflammatory drugs are prescribed. In rare cases, surgery is recommended; usually the indications for intervention are severe pain that cannot be relieved with medication. During the operation, the surgeon removes part of the abnormal vertebrae in the area of ​​the sacrum and lower back.

Complications associated with blocked vertebrae

Unfortunately, over the years, the condition of people suffering from concrescence worsens. When a person stops growing, intervertebral discs begin to degenerate. The rigidity of the back muscles increases, and scoliosis may develop. Pathologies of the heart and other organs are recorded.

In addition to the above deviations, one can also note the phenomenon of sacralization, when the L5 vertebra passes into the sacral region and fuses with the first sacral vertebra S1. There is also a reverse process called lumbarization: the upper sacral vertebra moves into the lumbar region. Such complications are always associated with severe pain.

Also, patients with concrescence may develop spondyloarthrosis and osteochondrosis.

The early appearance of pain in the cervical spine is often associated by patients and doctors with osteochondrosis, which arose due to a sedentary lifestyle. Most often, this is the case - osteochondrosis really makes you look younger, and there is nothing surprising in the fact that schoolchildren today suffer from diseases of the elderly. However, occasionally x-rays show deviations from the normal anatomical structure - congenital anomalies cervical spine.

Anomalies of the cervical spine most often occur in the craniovertebral zone, which includes the connection of the first cervical vertebra C1 (atlas) with the bones of the skull.

Malformations of the cervical spine today are found in approximately 8% of subjects, which is not so small.

Externally congenital pathologies vertebrae may not manifest themselves at all, or declare themselves to be moderate aching pain. The patient can remain confident all his life that he has cervical osteochondrosis, and the true cause is never found, or is discovered by chance during an examination for osteochondrosis. In other cases, the anomalies are accompanied by specific symptoms and severe brain disorders.

In the examined group of patients with neck anomalies, the following diagnoses were made:

• Hyperplasia of the cervical processes (cervical ribs) - about 23% of diagnoses.
• Kimmerle anomaly - 17.2%.
• Saddle hyperplasia of the atlas - 17.3%.
• posterior C1 (non-fusion of the arches of the atlas) - 3.3%.
• Assimilation of the atlas (fusion with the occipital bone) - 2%
• Concrescence (blocking) of the second and third vertebrae - 2.4%.

In other cases, other pathologies were discovered.

Congenital anomalies also include displacement of the cervical vertebrae, which occurs due to spondylolysis and birth injuries.

Cervical ribs

Sometimes the rudiments of the cervical ribs are excessively enlarged. Basically, this phenomenon is observed in the seventh cervical vertebra, but it also happens in others.

Cervical ribs can be of several degrees:

• Incomplete, ending freely in soft tissues:
  • first degree - do not extend beyond the transverse process;
  • second degree - do not reach the cartilaginous surface of the first thoracic rib;
  • third degree - fibrous flexible connection (syndesmosis).
• Complete, forming a connection with the first rib:
  • fourth degree - rigid bone connection (synostosis).

IN in some cases they can even reach the manubrium of the sternum.

More often, extra cervical ribs are found in women (although it seems biblical legend should be for men).

In two thirds of cases, the anomaly is paired.

Full cervical ribs change the anatomy of the neck:

• The brachial plexus and subclavian artery are displaced forward.
• The attachment of the anterior and middle scalene muscles changes:
  • they can be attached to the first thoracic rib, or to the cervical rib, or to both.
• The interscalene space may narrow.

Incomplete ribs of the first two degrees rarely cause any symptoms.

Symptoms of cervical ribs

In 90% of cases, the course is asymptomatic.

During external examination, a painless bony prominence may be observed and palpated.

With incomplete ribs, with pressure from the rib bone or fibrous cord on the shoulder nerve plexus, neurological symptoms may occur, especially when the neck is tilted towards the hypertrophied rib. Scalene muscle syndrome occurs:

• Pain and numbness in the neck, shoulder and arm.
• Muscle weakness, gaps form in certain areas of the muscle. It is impossible to work with raised arms and lift heavy objects.
• Fine motor skills are impaired.

Full cervical ribs provoke compression of the subclavian artery, which leads to impaired blood flow.

This may manifest itself as symptoms:

• impaired pulsation in the radial artery;
• damage to the walls of blood vessels;
• trophic disorders in blood vessels and skin ( skin cold; increased sweating);
• edema and cyanosis of the extremities.

In the most severe cases, thrombosis of the subclavian artery and gangrene of the arms are possible.

Treatment of cervical ribs

Treatment is for pain and in case of arterial compression.

Apply:

• Novocaine blockades
• Shants collar.
• Vasodilators.
• Drugs that absorb fibrous tissue.

With constant compression of the brachial plexus and adjacent nerve fibers Conservative treatment is ineffective, and surgery is recommended - resection of the cervical rib.

Kimmerle anomaly

Kemmerle's anomaly is a malformation of the craniovertebral junction associated with an atypical congenital defect of the atlas in the form of a bony arcuate septum on the posterior arch above the vertebral artery groove.

There are two types of partition:

• medial, connecting the articular process with the posterior arch;
• lateral, connecting the costotransverse process with the articular one.

The bony septum forms an abnormal channel around the artery, which can limit its movement when bending or turning the neck and lead to vertebral artery syndrome, disorders brain circulation and even to ischemic stroke(with constant compression of the vessel).

Symptoms of Kimmerle's anomaly

• Dizziness, headache.
• Hallucinogenic tinnitus (humming, ringing, rustling, crackling, etc.)
• Darkness in the eyes, floating “spots”, dots and other “objects”.
• Attacks of weakness sudden loss consciousness.
• Vegetovascular dystonia:
  • pressure surges;
  • insomnia;
  • anxious state.
• In later stages:
  • tremor in the limbs, numbness of the facial skin, nystagmus (trembling of the eyeball).

Treatment of Kimmerle anomaly

The anomaly is incurable, as it is associated with the design features of the Atlas. The only treatment is observation and adherence to a regimen of limited loads on the neck, with dosed physical therapy:

• Post-isometric relaxation and static exercises are preferable.

Patients with Kimmerle's anomaly need to sleep on an orthopedic pillow.

For symptoms of deficiency cerebral circulation prescribe:

• cinnarizine, cavinton, trental, piracetam, mildronate.

• medications for hypertension (eg, elanopril)
• sedatives (tincture of motherwort, valerian)
• tranquilizers (grandaxin, alprazolam).

All medications for Kimmerle anomaly and other developmental defects are prescribed exclusively by a neurologist.

The need for surgery for Kimmerle anomaly arises in as a last resort, when the diameter of the anomalous ring narrows to critical sizes.

Patients with this pathology need to periodically undergo Doppler scanning of the vessels of the cervical spine.

Saddle hyperplasia of the atlas

• With this anomaly, the lateral sides of the atlas are enlarged so much that they are higher than the upper point of the axis tooth (second cervical vertebra).
• The upper platform of the atlas at the junction with the condyles of the occiput is curved in the shape of a saddle.
• The posterior contour of the atlas's body rises above its arch.

Symptoms:

• Tension and pain in the back of the head and neck.
• Development of deforming arthrosis of the cervical-occipital joints.
• When the vertebral artery is compressed by the articular process of the occipital bone, vertebral artery syndrome is possible.

Treatment is symptomatic:

• Pain relief, muscle spasm relief and improved blood circulation.
• Therapeutic exercise.
• Massage, manual therapy.

Assimilation of Atlanta

Assimilation of the atlas is associated with its partial or complete fusion with the occipital bone.

The main dangers posed by this congenital malformation are two:

• Narrowing of the foramen magnum with the threat of compression of the medulla oblongata.
• Development of compensatory hypermobility in the lower cervical region (as a response to immobility of the upper craniovertebral region).

Symptoms of Atlanta assimilation

• Paroxysmal headaches, possible nausea and vomiting.
• Increased intracranial pressure.
• Symptoms of VSD:
  • tachycardia, blood pressure changes, sweating, panic attacks.

In the absence of brain compression, the symptoms of myelopathy with motor impairment are not pronounced.

Dissociated (separate) sensitivity disorders in the lower part of the cervical region are possible.

When the structures of the medulla oblongata are compressed, the symptoms depend on the level of compression of the cranial nerves:

• 9 - 11 pairs: dysphagia, sore throat, speech impairment, hoarseness, changes in taste.
• 8th pair (vestibular-cochlear nerve): decreased hearing, noise in the ear, nystagmus, dizziness.
• 7th pair of nerves: neuritis of the facial nerve.

Atlanta assimilation treatment

• Pain relief with analgesics and NSAIDs (diclofenac, meloxicam, ibuprofen).
• For severe pain, perform paravertebral blockades.
• Diuretics to reduce ICP (veroshpiron, diacarb).
• Reflexology.
• Electrophoresis, phonophoresis.
• Exercise therapy, massage.
• Craniosacral osteopathy.
• Stability of the neck in severe cases is maintained by the Schantz collar.

At a critical stage of assimilation, a surgical operation is performed:

• laminectomy;
• expansion of the foramen magnum:
• anterior and posterior spinal fusion of the lower cervical vertebrae.

Concrescence of the cervical vertebrae

Concrescence is the fusion of two or more vertebrae. In the cervical spine this can lead to (Klippel-Feil syndrome).

The vertebrae can be blocked partially (only the arches and spinous processes are fused) or completely (both the bodies and the arches are fused). Most often, the C2 and C3 vertebrae are blocked.

It is necessary to distinguish congenital concrescence from spondylosis and ankylosing spondylitis, since in these pathologies there is an acquired blockage due to progressive osteochondrosis or spondyloarthritis.

Diagnosis of cervical spine anomalies

• Anomalies of the bone structures of the cervical vertebrae are usually detected:
  • X-rays performed in the anterior and lateral projections.
  • Functional radiography (antero-posterior and lateral spondylograms performed in the position of maximum neck tilt).
• Brain dysfunctions in cervical anomalies are determined by:
  • Electroencephalography (EEG).
  • Echo-encephalography ( ultrasound diagnostics brain, allowing to determine intracranial pressure and pathological formations in the brain).
• Anomalies of the spinal canal of the cervical region, spinal cord and brain are usually examined using MRI.
• To examine the vessels of the head and neck, use:
  • Doppler ultrasound (USDG) of the vessels of the head and neck - studies the anatomy of blood vessels, blood flow speed, visualizes plaques, thickening of vessel walls, blood clots.
  • Rheoencephalography (REG) - determines the pulse blood flow in the arteries of the brain and venous drainage from the cranial cavity.

Treatment of cervical spine abnormalities

Treatment for any cervical abnormality is determined by its type and severity of symptoms. In most cases, some preliminary special treatment not required.

A pathology such as assimilation of the atlas is rarely diagnosed, but develops quite often. Partial or complete assimilation of the atlas by the occipital bone can be a congenital disease, but more often it becomes a consequence of an obstetric injury. During childbirth, primary dislocation or subluxation of the first cervical vertebra often occurs. In the future, this entails partial deformation of the atlas and its fusion with the occipital bone.

In adulthood, assimilation of the atlas by the occipital bone occurs against the background of poor posture, complete dislocation vertebra, as a result of impaired blood supply bone structure etc.

The first cervical vertebra, which normally should form a movable connection with the occipital bone, is called the atlas. This is the only vertebra that is practically devoid of a body. It is formed by the fusion of arches and has a spike-shaped tooth for connection with the second cervical vertebra located below. Inside the atlas there is a wide oval window through which the spinal cord exits the base of the skull. The grooves of the posterior vertebral arteries lie here. Normally, there is an atlanto-occipital joint, due to which various movements of the head are made.

If there is an anomaly in the structure of the atlas and its assimilation by the occipital bone, the process of blood supply to the posterior structures of the brain is disrupted. Often this pathology is combined with splitting of the posterior vertebral arch. In this case, a cyst may form at the base of the skull.

With complete fusion, mobility is responsible. Partial assimilation does not give visible clinical signs that would allow one to suspect the presence of pathology. In a process accompanied by deformation of the vertebral arches, craniovertebral insufficiency may be observed due to compression of the medulla oblongata by the upper parts of the spinal cord. The second clinically significant sign is the instability of the position of the underlying cervical vertebrae and the destruction of intervertebral discs due to this. Very often, assimilation of the atlas in adults is discovered by chance during examinations against the background of diagnosing cervical osteochondrosis.

If pathology is detected early, complete recovery is possible with conservative treatment. In advanced cases, when the patient has pronounced signs of compression of the spinal cord and brain, a surgical operation is performed, during which the physiological structure of the articulation of the first cervical vertebra and the occipital bone is restored. To carry out a differential diagnosis, a simple x-ray is often sufficient, which will show the unnatural position of the atlas and the absence of a cleft of the atlanto-occipital joint.

If you require conservative treatment for this pathology, you can make an appointment for a free appointment with a vertebrologist in Moscow at our manual therapy clinic. The doctor will conduct a manual examination and give individual recommendations for a course of rehabilitation therapy.

Assimilation of the posterior arch of the atlas

In the diagnosis of congenital pathologies, assimilation of the posterior arch of the atlas is the leader; it is often associated with Kimerli and Chiari anomalies of intrauterine development. Symptoms of these defects may first appear in quite mature age when a person reaches 20 years of age. Therefore, there is a misconception that all cases of fusion of the atlas with the occipital bone are exclusively acquired due to the development of cervical osteochondrosis or curvature of the spinal column.

Actually this is not true. When the posterior arch is affected, the etiology of the disorder in intrauterine development of the fetus is almost always indisputable. Ossification of the cervical spine is completely completed by the age of 22. At this time, the final formation of all physiological curves occurs. If there are congenital deformities, they are covered with deposits of calcium salts. Thus, the assimilation of the Atlas occurs gradually from the moment of birth until the age of 20 - 22 years. All this time, deformation processes and ideas of tissue filling with calcification deposits occur in the cavity of the atlanto-occipital joint. A bone callus is formed.

Basilar impression is a condition that accompanies the assimilation of the posterior arch of the atlas and is expressed in the displacement of the occipital bone with a compensatory shift of the first vertebra in relation to the second.

During the normal process of ossification, the articular processes of the first vertebra remain mobile, but are tightly adjacent to the endplates of the condyles of the occipital bone. During the assimilation process, a dystrophic change in the endplates and complete degeneration of the cartilaginous synovial layer in the articular plane occurs. This provokes quite strong friction of the vertebra against the surface of the occipital bone during head movement. Cracks form on the surfaces and are filled with calcium salts. This begins the process of fusion of the cervical vertebrae with the occipital bone.

Reduction of the internal volume of the cranial fossa and disruption of the posterior vertebral arteries leads to persistent headaches, decreased mental performance, dizziness and other manifestations of vertebrobasilar vascular insufficiency.

Such a developmental anomaly must be diagnosed in a timely manner. With complete fusion, effective medical care can only be provided through surgery. Therefore, when characteristic symptoms Consult a doctor immediately and undergo a full clinical examination in order to make an accurate diagnosis.

Etiology of cervical vertebral fusion

Fusion of the cervical vertebrae proceeds extremely slowly. Primary pathological changes are formed at the embryonic stage of intrauterine development. Craniovertebral structures in infancy and childhood can be formed in a completely physiological manner. There will be no noticeable defects.

Genetically determined fusion of the cervical vertebrae can be provoked by the following negative influence factors:

• leading an unhealthy lifestyle;
• work of future parents in hazardous industries, including those with an increased background of radio emission;
• smoking and drinking alcoholic drinks during pregnancy;
• wearing tight clothing that compresses the abdominal area;
• injuries during childbearing;
• various congenital pathologies in male and female line affecting the connective, cartilaginous and bone tissue;
• diabetes mellitus, disruption thyroid gland, chronic aplastic anemia, heart failure and chronic diseases lungs of the expectant mother;
• all types of toxicosis, nephropathy, placental insufficiency and abruption, bleeding, threat of miscarriage and premature birth;
• infectious lesions (cytoplasmosis, trichomonas, hepatitis and herpes virus, etc.).

When the site of assimilation is formed, a secondary narrowing of the foramen magnum may occur. As a result, compression pressure on the structures increases posterior sections brain. If the medulla oblongata is damaged, the patient's mnestic functions may be impaired. In combination with compression of the upper spinal cord in the cervical spine, this leads to the appearance flaccid paresis and paralysis, loss of coordination of movements.

Also, deformation of the foramen magnum may not occur. But with the second type of fusion development, a complete cessation of mobility occurs. On initial stage this is a significant decrease in the amplitude of mobility. Then the mobility of the lower cervical vertebrae begins to increase. This preserves the overall mobility of the cervical spine and the ability to make normal head movements. Hyperlability leads to rapid destruction of intervertebral discs C4-C5 and C5-C6. Patients with assimilation of the atlas are most often referred to for their protrusion and the appearance of intervertebral hernia. And only through a series of x-rays is it possible to identify the pathology.

Symptoms of incomplete fusion (assimilation) of the vertebrae

Incomplete fusion of the vertebrae and occipital bone may not produce clinical symptoms over a long period of time. Often, signs of the development of secondary degenerative dystrophic disease of the intervertebral discs of the cervical spine come to the fore.

The following clinical signs of pathology may be expressed:

1. paroxysmal headaches that are localized behind the ears and in the occipital region;
2. increased sweating;
3. attacks of increased heart rate (tachycardia with heart rate over 120 beats per minute);
4. jumps in blood pressure from sharp decline until its level increases, regardless of physical activity and time of day;
5. feeling of heat or sudden cold without a change in temperature environment;
6. pressure in the head and feeling of fullness;
7. pressure on the eyeballs from the inside;
8. nosebleeds;
9. nausea and attacks of dizziness, sometimes cerebral vomiting may occur at the height of the headache.

Patients have a predominantly depressive mood, often developing vegetative-vascular dystonia at a young age, and arterial hypertension at an older age. Mental performance decreases. During adolescence, school failure occurs. In student years it manifests itself in the form chronic fatigue and inability to remember material in school.

With secondary functional lability of the lower cervical vertebrae, clinical picture cervical osteochondrosis:

• severe pain in the neck and collar area;
• stiffness of movements in the morning;
• poor posture;
• pain in the upper extremities;
• muscle tension in the neck and collar area.

When the spinal canal and foramen magnum are deformed, serious dysfunctions may occur in the form of paralysis, paresis, and myelopathy. All clinical cases hearing loss, a sharp decrease in visual acuity, and the appearance of nystagmus are indications for differential diagnosis of atlas assimilation.

To diagnose atlas assimilation, sometimes a thorough examination by a vertebrologist with manual examination is sufficient. To confirm the preliminary diagnosis, a series of x-rays and an MRI examination are prescribed.

Atlanta assimilation treatment

Fusion of the spinous processes of the cervical vertebrae and assimilation of the atlas in the early stages is amenable to conservative treatment. IN official medicine are used predominantly symptomatic methods impact. During exacerbations, the patient is prescribed nonsteroidal anti-inflammatory drugs, diuretics, and medications to relieve attacks of tachycardia, increase or decrease blood pressure. A similar treatment is carried out for cervical osteochondrosis using chondroprotectors.

Manual therapy offers a fundamentally different approach to treatment. With the help of a specially developed individual course, the vertebrologist restores the mobility of the atlanto-occipital joint. For this purpose, therapeutic exercises and kinesiotherapy, massage and osteopathy, reflexology, laser exposure and physiotherapy are used.

If you need treatment for atlas assimilation and spinous process fusion, you can seek primary free consultation vertebrologist in our manual therapy clinic. Here you will be given an accurate diagnosis. An experienced doctor will tell you about all the possibilities and prospects for treatment.