Case report
Aplasia of the posterior arches of the atlas: A presentation of 2 cases
Aplasia de los arcos posteriores del atlas: a propósito de 2 casos
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Quinteiro Antolín, I. Castellano Romero, J. Yáñez Calvo" "autores" => array:3 [ 0 => array:4 [ "nombre" => "T." "apellidos" => "Quinteiro Antolín" "email" => array:1 [ 0 => "tqa1981@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "I." "apellidos" => "Castellano Romero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J." "apellidos" => "Yáñez Calvo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Unidad de Cirugía de Mano, Servicio de Cirugía Ortopédica y Traumatología, Hospital de Verín, Verín, Orense, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aplasia de los arcos posteriores del atlas: a propósito de 2 casos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1820 "Ancho" => 1300 "Tamanyo" => 242666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(A) Lateral radiograph of case 1. (B) Lateral radiograph of case 2, showing a remnant of the right arch. (C) 3D CT scan image of case 1.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Alterations in the posterior arches of the atlas are rare anomalies (<4% among the general population<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>) which are usually associated with some type of syndrome, such as Klippel–Feil, Turner, Di Giorge or Arnold–Chiari, and also with other alterations of the axial skeleton (torticollis, spina bifida, short neck, etc.),<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> so their presence in healthy patients is rare.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Currarino et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> classified defects in the posterior arches of the atlas into different degrees, as shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">We present 2 cases of Currarino type D congenital aplasia of the posterior arches of the atlas.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">The patient was a 54-year-old woman with a history of intervention due to right carpal tunnel syndrome (CTS). She attended consultation due to cervicalgias of long duration, which she suffered 13<span class="elsevierStyleHsp" style=""></span>years earlier linked to a car accident. She also reported suffering frequent cervical contractures, with pain radiating to the right deltoid and occasional headaches with tensional characteristics (2–3/month). In addition, she suffered occasional mild paresthesias and slight loss of strength in both hands, more noticeable on the right side. She reported taking NSAIDs during the symptomatic periods, with only temporary improvement.</p><p id="par0025" class="elsevierStylePara elsevierViewall">We observed a moderate contracture of the cervical paravertebral and trapezoid musculature (more noticeable on the right side), with mild pain on palpation. Her cervical mobility presented scarce functional limitation, as well as discomfort in the limbs, without radiation. The Valsalva and Lhermitte signs were negative.<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">–</span><p id="par0030" class="elsevierStylePara elsevierViewall">Fist strength: right – 10<span class="elsevierStyleHsp" style=""></span>kgf; left – 20<span class="elsevierStyleHsp" style=""></span>kgf (JAMAR<span class="elsevierStyleSup">®</span> dynamometer).</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">–</span><p id="par0035" class="elsevierStylePara elsevierViewall">Grip strength: right – 4<span class="elsevierStyleHsp" style=""></span>kgf; left – 5<span class="elsevierStyleHsp" style=""></span>kgf (JAMAR<span class="elsevierStyleSup">®</span> dynamometer).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">–</span><p id="par0040" class="elsevierStylePara elsevierViewall">Strength in lower limbs (LL): 5/5.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">–</span><p id="par0045" class="elsevierStylePara elsevierViewall">Preserved and symmetrical osteotendinous reflexes (OTR) in upper limbs (UL) and LL.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">–</span><p id="par0050" class="elsevierStylePara elsevierViewall">Normal sensitivity.</p></li></ul></p><p id="par0055" class="elsevierStylePara elsevierViewall">Simple radiography (Rx) revealed the existence of a defect in the posterior arch of C1 with a preserved posterior tubercle (Currarino type D). We verified the stability of the tubercle through Rx in flexion and extension (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">A computed tomography (CT) scan confirmed aplasia of the posterior arches of C1, with a preserved posterior tubercle (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C). A magnetic resonance imaging (MRI) scan did not report any findings suggestive of spinal disorders.</p><p id="par0065" class="elsevierStylePara elsevierViewall">We decided to follow a conservative treatment with exercises to strengthen the cervical muscles, stretching and postural hygiene. We recommended avoiding any situations which could cause hyperextension of the neck.</p><p id="par0070" class="elsevierStylePara elsevierViewall">After several months of treatment, the patient reported slight improvement of headaches and neck pain.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Case report 2</span><p id="par0075" class="elsevierStylePara elsevierViewall">The patient was a 6-year-old boy, with no previous relevant history, who presented cervical pain of several weeks duration after suffering trauma whilst tumbling.</p><p id="par0080" class="elsevierStylePara elsevierViewall">Physical examination did not appreciate contractures or facial asymmetry. There was slight discomfort on palpation of the paravertebral cervical and trapezoid musculature.</p><p id="par0085" class="elsevierStylePara elsevierViewall">Cervical mobility was complete, with normal strength for the age, and without pain or alteration of OTR. Sensitivity was also normal.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Plain Rx (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B) showed a defect in the posterior arch of the atlas (Currarino type D). We verified the stability of the remaining bone of the posterior arch with Rx in flexion and extension. We also obtained an MRI scan which confirmed the defect of the posterior arches of the atlas, with traces of the right arch and tubercle, and without spinal alterations.</p><p id="par0095" class="elsevierStylePara elsevierViewall">In the absence of symptoms, the patient is currently advised to avoid any activity or situation which might cause cervical hyperextension.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0100" class="elsevierStylePara elsevierViewall">The evolution of both patients is satisfactory.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Alterations of the posterior arch of the atlas are rare (<4%). This is especially true of type D cases, such as those presented in this work, which have a prevalence under 0.2%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">When not associated with a syndrome (Down, Turner, Di Giorge, etc.), these patients are usually asymptomatic and the finding is incidental,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> mostly due to imaging studies performed after trauma or chronic neck pain.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a> More rarely, patients may present cervicobrachialgia,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Lhermitte's sign upon mobilising the neck,<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> significant loss of strength and even transient tetraparesis after minimal trauma.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,7</span></a></p><p id="par0115" class="elsevierStylePara elsevierViewall">Regarding treatment, the literature contains reports supporting different opinions. Some authors recommend treating all patients who retain the posterior tubercle by removing it, thus avoiding the risk of impaction on the spinal cord,<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> whilst others support conservative treatment, with or without preventive measures, reserving surgery only for those cases with clear and proven symptoms due to compression by the tubercle.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,4</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">In our case, we decided to follow a conservative treatment, avoiding situations of risk, since there were no spinal alterations or signs of instability. We consider that, as a general rule, excision of the tubercle is overly aggressive in patients with no symptoms and may even cause instability. Moreover, we do not consider it to be indicated since, in the review by Senoglu et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> most cases were incidental findings.</p><p id="par0125" class="elsevierStylePara elsevierViewall">In cases showing neurological symptoms, we advocate testing these symptoms by means of dynamic nuclear magnetic resonance (NMR) and excision of the tubercle.</p><p id="par0130" class="elsevierStylePara elsevierViewall">In conclusion, we believe that abnormalities of the posterior arches of the atlas are rare and usually asymptomatic, although potentially dangerous for the spine. Unfortunately, the literature is scarce and with a low level of evidence. Therefore, we believe it would be interesting to study more cases, in order to establish the possible indications for surgery and the usefulness of preventive measures (such as restricting sports activities or using a rigid collar when in cars), or whether these cases are benign deviations from the standard and do not require treatment or prevention.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Level of evidence</span><p id="par0135" class="elsevierStylePara elsevierViewall">Level of evidence V.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical responsibilities</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Protection of people and animals</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that this investigation did not require experiments on humans or animals.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Confidentiality of data</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Right to privacy and informed consent</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors declare that this work does not reflect any patient data.</p></span></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "xres116638" "titulo" => array:4 [ 0 => "Abstract" 1 => "Introduction" 2 => "Case report" 3 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec103922" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "xres116637" "titulo" => array:4 [ 0 => "Resumen" 1 => "Introducción" 2 => "Casos clínicos" 3 => "Conclusiones" ] ] 3 => array:2 [ "identificador" => "xpalclavsec103923" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Case report 1" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Case report 2" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Discussion" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Level of evidence" ] 10 => array:3 [ "identificador" => "sec0035" "titulo" => "Ethical responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0050" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2011-12-11" "fechaAceptado" => "2012-05-28" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec103922" "palabras" => array:4 [ 0 => "Aplasia" 1 => "Atlas" 2 => "Cervicalgia" 3 => "Spine" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec103923" "palabras" => array:4 [ 0 => "Aplasia" 1 => "Atlas" 2 => "Cervicalgia" 3 => "Médula" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Aplasia of the posterior arches of the atlas is an uncommon condition caused by a defect in their closure. It is usually associated with different syndromes.</p> <span class="elsevierStyleSectionTitle">Case report</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We present 2 asymptomatic patients with aplasia of C1 posterior bodies.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Further studies are required on these lesions in order to take possible protection measures against trauma, and the selection between conservative or surgical treatment.</p>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Introducción</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La aplasia de los cuerpos posteriores del atlas es una afección poco frecuente, causada por un defecto en el cierre de los mismos. Habitualmente se asocia a diferentes síndromes.</p> <span class="elsevierStyleSectionTitle">Casos clínicos</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Presentamos 2 casos clínicos de pacientes asintomáticos con aplasia de los cuerpos posteriores del atlas.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Es necesario estudiar más a fondo este tipo de lesiones de cara a valorar la posibilidad de tomar medidas de protección ante traumatismos y escoger entre el tratamiento conservador y el quirúrgico.</p>" ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Quinteiro Antolín T, et al. Aplasia de los arcos posteriores del atlas: a propósito de 2 casos. Rev Esp Cir Ortop Traumatol. 2012;<span class="elsevierStyleBold">56</span>:381–4.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1820 "Ancho" => 1300 "Tamanyo" => 242666 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">(A) Lateral radiograph of case 1. (B) Lateral radiograph of case 2, showing a remnant of the right arch. (C) 3D CT scan image of case 1.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Type \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" style="border-bottom: 2px solid black">Corresponding malformation \t\t\t\t\t\t\n \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fusion defect at the level of the midline of the half arches \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Unilateral defect \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bilateral defect \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">D \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absence of the posterior arches, with a preserved posterior tubercle \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">E \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Absence of the posterior arches and the posterior tubercle \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab204494.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Classification of anomalies of the posterior arches of the atlas elaborated by Currarino.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The frequency and clinical significance of congenital defects of the posterior and anterior arch of the atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Senoglu" 1 => "S. Safavi-Abbasi" 2 => "N. Theodore" 3 => "N.C. Bambakidis" 4 => "N.R. Crawford" 5 => "V.K. Sonntag" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/SPI-07/10/399" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg Spine" "fecha" => "2007" "volumen" => "7" "paginaInicial" => "399" "paginaFinal" => "402" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17933313" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Torticollis in children caused by congenital anomalies of the atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. 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Hensinger" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Spine" "fecha" => "1986" "volumen" => "11" "paginaInicial" => "323" "paginaFinal" => "333" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3750062" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital defects of the posterior arch of the atlas: a report of seven cases including an affected mother and son" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Currarino" 1 => "N. Rollins" 2 => "J.T. Diehl" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "1994" "volumen" => "15" "paginaInicial" => "249" "paginaFinal" => "254" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8192068" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Congenital posterior atlas defect associated with anterior rachischisis and early cervical degenerative disc disease: a case study and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "D. Pasku" 1 => "P. Katonis" 2 => "A. Karantanas" 3 => "A. Hadjipavlou" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Orthop Belg" "fecha" => "2007" "volumen" => "73" "paginaInicial" => "282" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17515248" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Partial aplasia of the posterior arch of the atlas with an isolated posterior arch remnant: findings in three cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Sharma" 1 => "S.B. Gaikwad" 2 => "P.S. Deol" 3 => "N.K. Mishra" 4 => "S.S. Kale" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "AJNR Am J Neuroradiol" "fecha" => "2000" "volumen" => "21" "paginaInicial" => "1167" "paginaFinal" => "1171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10871035" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lhermitte sign during yawning associated with congenital partial aplasia of the posterior arch of the atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Sagiuchi" 1 => "S. Tachibana" 2 => "K. Sato" 3 => "S. Shimizu" 4 => "I. Kobayashi" 5 => "H. Oka" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Neuroradiol" "fecha" => "2006" "volumen" => "27" "paginaInicial" => "258" "paginaFinal" => "260" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16484387" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Recurrent transient quadriparesis after minor cervical trauma associated with bilateral partial agenesis of the posterior arch of the atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Torreman" 1 => "I.T. Verhagen" 2 => "M. Sluzewski" 3 => "A.J. Kok" 4 => "W.J. Van Rooij" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3171/jns.1996.84.4.0663" "Revista" => array:6 [ "tituloSerie" => "J Neurosurg" "fecha" => "1996" "volumen" => "84" "paginaInicial" => "663" "paginaFinal" => "665" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8613860" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000005600000005/v1_201305031814/S1988885612000806/v1_201305031814/en/main.assets" "Apartado" => array:4 [ "identificador" => "7586" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000005600000005/v1_201305031814/S1988885612000806/v1_201305031814/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885612000806?idApp=UINPBA00004N" ]
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