Evaluation and treatment of congenital and developmental anomalies of the cervical spine

Congenital and developmental osseous abnormalities of the cervical spine can result in neural compression ranging from the medulla oblongata to the cervicothoracic spinal cord junction. These may present in infancy as scoliosis and even limb weakness. A high index of suspicion is essential. Neurodiagnostic imaging relies on high-resolution computerized tomography (CT) scanning and three-dimensional CT reconstructions as well as magnetic resonance imaging and angiography. The anatomical/physiological CT factors considered when developing a surgical approach are: 1) the stability and reducibility of the lesions; 2) direction and manner of encroachment of the lesion on the neural structures; 3) neural and vascular abnormalities; and 4) growth potential of the affected area. Primary stabilization is required for reducible lesions, whereas irreducible lesions are decompressed in the manner in which encroachment has occurred. Instability, whether present before or after operative intervention, required spinal stabilization. Illustrative examples of this approach are presented.