PubMed · 5392052
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P Siebert. 1969. [The paracondyloid process].. https://pubmed.ncbi.nlm.nih.gov/5392052/
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James Platt White, MD (1811-1881), one of the founders and leading figures of the Buffalo Medical College and a pioneer in American obstetrics and gynecology, suffered an interesting and remarkable accident to his neck at the age of 26 while traveling in a stagecoach in Western New York. He was confined to bed until after 45 days, a piece of bone was discharged into his pharynx and then expectorated. The segment of bone proved to be the anterior arch of his atlas (C1) vertebra. He recovered completely from this injury except for permanent loss of rotation of his head and neck. However, he was without functional disability until his death, 44 years later, at the age of 70. This case documents the clinical result during a 44-year period after traumatic loss of the anterior arch of C1. Such cases have been reported only rarely in the literature. Only limited information is available regarding the long-term clinical significance of a Jefferson fracture with exfoliation of the anterior arch of C1. My analysis suggests that White suffered an open Jefferson's fracture that became infected. The anterior arch of C1 became a sequestrum and was discharged spontaneously into his pharynx and then expectorated. This case report with decades of followup should be of interest to all who care for patients with cervical spine injuries and those who are interested in the history of medicine in Western New York.
We report a rare case of giant cell tumor in the atlas. A 50-year-old female presented with severe pain in her right neck and shoulder. The preoperative magnetic resonance images showed a tumor mixed with solid and cystic components in the right side of the atlas. CT scan showed that the anterior and posterior arches of the atlas were destroyed. Preoperative biopsy led to the pathological diagnosis of giant cell tumor with multinuclear giant cells and mononuclear stromal cells. A preoperative vertebral angiogram demonstrated tumor stain supplied from the muscular branches. To reduce intraoperative bleeding, the embolization of the right vertebral artery by GDC was performed before surgical removal. The tumor was subtotally removed following ligation of the right external carotid artery to reduce bleeding of tumor. We used the Olerud cervical system to prevent cervical instability after resection of the tumor. Although the symptoms disappeared completely after surgery, regrowth of tumor was observed in follow-up MRI 4 months after the operation. For this reason, local radiation therapy was performed (50 Gy). Then, the size of the tumor has not changed in the 1.5 years since the operation.
An unusual case of partial aplasia of the posterior arc of the atlas, with persistent posterior tubercle, is presented in a previously healthy individual who sustained a neck trauma. Both plain X-rays and CT findings specified the lesion. Dynamic X-rays in flexion and extension showed an immobile posterior tubercle. The patient did not develop neurological symptoms at any stage during follow-up (1 year).