PMC5458705_01
(a) Clinical photograph showing the presence of swelling (black arrows) in the posterior part of the neck. (b) Lateral radiograph of the cervical spine clearly shows overgrowth (arrow) and elongation of the spinous process of the C5 cervical vertebra. (c) anteroposterior radiograph of the cervical spine shows hemivertebra at C4 level (arrow).
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F1
The swelling was located in midline of the neck posteriorly (Fig. 1a). Radiographic assessment of the cervical spine with lateral radiograph revealed an elongated and abnormal shaped spinous process of C5 vertebrae (Fig. 1b). Anteroposterior radiograph of the cervical spine showed an abnormal bony curvature of the cervical spine due to C4 hemivertebra formation (Fig.1c).
(a and b) Sagittal and axial computed tomography scans passing through C5 vertebra show the presence of pseudoarticulation at the base of the spinous process. Hypertrophy of the left lamina of C5 is also evident (arrow). (c and d) Coronal and three-dimensional reconstruction better showing hemivertebra at the C4 level.
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F2
Asteion showed hyperplasia of lamina and spinous process of C5 vertebrae (Fig. 2a). Associated non union of the elongated C5 spinous process was noted (Fig. 2b). The hemivertebra of C4 vertebra was also better defined on CT scan (Fig. 2c). Three-dimensional CT reconstruction images of cervical spine were also generated to delineate the anatomy (Fig. 2d).
Post-operative lateral view X-ray.
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F3
Due to the limited nature of the patient's complaints, only excision of the elongated spinous process at the level of pseudoarthrosis was done with ease through posterior approach without any complication (Fig. 3), and specimen was sent for histopathological examination, which was unremarkable.