Background: A congenitally missing cervical pedicle should be part of the differential diagnosis when evaluating a patient with a traumatic injury to the cervical spine to prevent unnecessary surgical intervention. Patients having this congenital abnormality usually present after traumatic incidents and therefore are commonly misdiagnosed as a cervical fracture or dislocation. Radiographic imaging showing a missing cervical pedicle should be further investigated in order to avoid misdiagnosis and needless treatment. This report is published to increase awareness among physicians about congenitally missing cervical pedicle.
Case presentation: A 17 year old obese female patient presented to the ER with neck pain after a motor vehicle crash. Neurological and physical exam were unremarkable except for neck stiffness. Computed tomography scan of the cervical spine revealed a missing left sided C6 pedicle. The patient was initially diagnosed with a C5-C6 subluxation and prescribed a halo vest until further evaluation and additional imaging. CT scan confirmed a left side C6 congenital missing pedicle, halo was removed and patient was treated by conservative measures.
Conclusion: In reviewing more than 70 articles from literature, congenital missing cervical pedicles are identified as a rare finding and often misdiagnosed especially when presenting after traumatic accidents. Careful review of literature proves that conservative measures are treatment of choice. Also restrictions regarding physical activity imposed after diagnosis is more precautionary rather than absolute.
Key words: Missing pedicle, congenital missing pedicle, missing cervical pedicle
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