Presentation
Neck pain and tenderness post fall.
Patient Data
Well-corticated bony fragment superior to the dens most likely represents a persistent ossiculum terminale.
Multilevel degenerative disease most severe at C5/6 and C6/7 with loss of intervertebral disc space height and partial fusion of C6 and C7 vertebral bodies. Minimal anterolisthesis C4 on C5 is almost certainly a result. Anterolateral osteophytes from C3-C7 with multiple lucencies that appear well corticated and are not acute fractures. Moderate facet joint arthropathy. Rounded lucency in the right C5 articular process has a slightly unusual appearance that may reflect a subchondral cyst/geode or an hemangioma, although more aggressive lesions cannot be excluded on this study.
No acute cervical spine fracture or malalignment demonstrated. Prevertebral soft tissues are within normal limits.
Case Discussion
The differential diagnosis of a persistent ossiculum terminale, which is a normal variant, includes:
- os odontoideum (larger)
- dens fracture (irregular, non-corticated edges)
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