Dystrophic changes of the spine in a patient with Kimmerle anomaly on the example of a clinical case

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Abstract

Of all diseases of the musculoskeletal system, degenerative changes of the spinal column occupy the first place in frequency. Especially in recent years, cases of diagnosis of dystrophic changes in the vertebrae and intervertebral discs in children have become more frequent, which indicates the rejuvenation of this pathology, and, as a result, an increase in cases of disability of the young population.

The presence of congenital defects of the vertebral apparatus is important for the rate of progression of the disease. Such an innate feature is considered to be the Kimmerle anomaly. Several variants of the Kimmerle anomaly are known: 1) ossification is observed between the articular process of the atlas (C1) and its posterior arch; 2) the bone arch connects the articular process of the Atlas and its transverse process. Pathology can be unilateral or bilateral, and the bone arch may be complete or incomplete, then the bone bridge remains unclosed in the form of an arched outgrowth.

In the presence of connective tissue dysplasia at the same time, even in the most minimal manifestations, and Kimmerle anomaly, a more rapid development of denegerative changes of the cervical spine can be observed.

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About the authors

V. P. Kutsenko

Saint Petersburg State Pediatric Medical University

Author for correspondence.
Email: val9126@mail.ru
ORCID iD: 0000-0001-9755-1906

Candidate of Medical Sciences

Russian Federation, Saint Petersburg

D. D. Kovaleva

Saint Petersburg State Pediatric Medical University

Email: val9126@mail.ru
ORCID iD: 0000-0002-6236-4526
Russian Federation, Saint Petersburg

R. A. Postanogov

Saint Petersburg State Pediatric Medical University

Email: val9126@mail.ru
Russian Federation, Saint Petersburg

S. V. Menshikova

Saint Petersburg State Pediatric Medical University

Email: val9126@mail.ru
Russian Federation, Saint Petersburg

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2. Fig. 1. Variants of ossification of the posterior atlanto-occipital membrane: a – unilateral lateral bridge, б – bilateral symmetrical complete Kimmerle anomaly (posterior and lateral bridges), в – unilateral posterior bridge (according to Alekseeva N.T., Karandeeva A.M., Kvaratskheliya A.G. et al., 2013)

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3. Fig. 2. Examination of the spine C1-C2, dose 18.66 dGr•cm2: the sagittal size of the spinal canal is normal; the functional test with flexion is satisfactory; there is a slight hypermobility associated with weakness of the ligamentous-muscular apparatus of the neck

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4. Fig. 3. Digital radiographs of the C1-C2 cervical spine: asymmetry of articular slits is observed through the mouth, the gap on the right is narrower than on the left, which may indicate rotation of the vertebrae. In the lateral projection there is an initial calcification of the atlanto-occipital ligament C1 – Kimmerle anomaly

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5. Fig. 4. MRI of patient A.: а – 16 years old (2014); б – 17 years old (2015); в –19 years old (2017); г – 22 years old (2020–2021)

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6. Fig. 5. CT scan of the cervical spine of patient A.

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