Presentation
History of trauma three days ago. Hyperreflexia in clinical examination.
Patient Data
Decreased interspinous interval of C2 and C3 with visible osseous structure at the spinous process of C2 posteriorly.
Spina bifida of C2 with unfused right segment of the spinous process. The posterior part of the right segment of C2 spinous process is completely corticated and unfused suggestive of unfused accessory ossicication center.
The anterior part of the right segment of C2 spinous process is projecting anteriorly, indenting the posterior aspect of thecal sac.
An anterior osseous projection from the spinous process of C2 is seen encroaching upon the spinal canal indenting the posterior aspect of the cervical spinal cord at the same level. No related compressive myelopathy identified.
Case Discussion
The spinous process cleft of C2 is likely representing spina bifida occulta. In this case, it is associated with anterior bony projection indenting the posterior aspect of the cervical spinal cord, which is likely the cause of the patient's hyperreflexia. No trauma-related MRI changes could be noted. This is likely to be congenital and the patient was generally asymptomatic the years before.
Spinal osteochondroma is a differential, which typically involves the posterior elements and can be rarely symptomatic.
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