Published date: Jun 30 2022

Journal Title: Sudan Journal of Medical Sciences

Issue title: Sudan JMS: Volume 17 (2022), Issue No. 2

Pages: 244–251

DOI: 10.18502/sjms.v17i2.11458

Assad Rezigallaassadkafe@yahoo.comDepartment of Basic Medical Sciences, Faculty of Medicine, University of Bisha, Saudi Arabia

Abdelrahman AliDepartment of Surgery, Military Hospital (Omdurman), Omdurman, Sudan

Introduction: The spinous process is part of the vertebrae and provides muscle attachment for some muscles and ligaments. They are important landmarks and play a role in screw placement during surgical intervention. This report describes a case of a Sudanese with a short cervical spinous process and draws attention to the possibility of anatomical variations in general and the shortage of cervical spinous processes specifically.

Case Report: A 70-year-old Sudanese male presented to the emergency department following a road traffic accident. After standard management and patient stabilization, the X-ray showed that the spinous processes of C 3, 4, and 5 cervical vertebrae were short, and those of C 6 and 7 have abnormal anatomy. The inter-spinous distances were well-maintained. The joints and articulations processes of cervical vertebrae were normal without cortication. The patient was stable and admitted for 24 hr for observation and then discharged on analgesics.

Conclusion: This is the first case report of the short spinous process among Sudanese. Some of the cervical spinous processes were short, and others had abnormal anatomy. No obvious manifestations were linked to the case. Discussion of anatomical variations should be carried out and implemented with care and in line with the normal and latest developments in biological, anthropology, forensic, and related sciences. Such anatomical abnormality should be considered during radiographing, preparation, and surgical intervention planning. The normal adaption resulting from congenital abnormality or variation can be used as a method for reconstruction surgeries and provides alternatives to clinical management.

Keywords: short spinous process, cervical, Sudanese, anatomical variation

[1] Swartz, E. E., Floyd, R., and Cendoma, M. (2005). Cervical spine functional anatomy and the biomechanics of injury due to compressive loading. Journal of Athletic Training, vol. 40, no. 3, p. 155.

[2] Drake, R., Vogl, A. W., and Mitchell, A. W. M. (2019). Gray’s anatomy: For students. USA: Elsevier Health Sciences.

[3] Nambiar, S., Mogra, S., Nair, B. U., et al. (2014). Morphometric analysis of cervical vertebrae morphology and correlation of cervical vertebrae morphometry, cervical spine inclination and cranial base angle to craniofacial morphology and stature in an adult skeletal class I and class II population. Contemporary Clinical Dentistry, vol. 5, no. 4, pp. 456–460.

[4] Rao, E. V., Rao, S., and Vinila, S. (2016). Morphometric analysis of typical cervical vertebrae and their clinical implications: a cross sectional study. International Journal of Anatomy and Research, vol. 4, no. 4.1., pp. 2988–2992.

[5] Chen, C., Ruan, D., Wu, C., et al. (2013). CT morphometric analysis to determine the anatomical basis for the use of transpedicular screws during reconstruction and fixations of anterior cervical vertebrae. PloS One., vol. 8, no. 12, p. e81159.

[6] Kaplan, K. M., Spivak, J. M., and Bendo, J. A. (2005). Embryology of the spine and associated congenital abnormalities. The Spine Journal, vol. 5, no. 5, pp. 564–576.

[7] Kim, H. J. (2013). Cervical spine anomalies in children and adolescents. Current Opinion in Pediatrics, vol. 25, no. 1, pp. 72–77.

[8] Richardson, P., Drake, R. L., Horn, A., et al. (2018). Gray’s basic anatomy. China: Elsevier Health Sciences.

[9] Rameez, F., Mufti, M., and Hilal, K. (2017). Hyperplasia of Lamina and Spinous Process of C5 Vertebrae and Associated Hemivertebra at C4 Level. Journal of Orthopaedic Case Reports, vol. 7, no. 1, pp. 79–81.

[10] Ludwisiak, K., Podgórski, M., Biernacka, K., et al. (2019). Variation in the morphology of spinous processes in the cervical spine–An objective and parametric assessment based on CT study. PloS One, vol. 14, no. 6, p. e0218885.

[11] Farooqi, R., Mehmood, M., and Kotwal, H. (2017). Hyperplasia of lamina and spinous process of C5 vertebrae and associated hemivertebra at C4 level. Journal of Orthopaedic Case Reports, vol. 7, no. 1, pp. 79–81.

[12] Solomon, B. D., Raam, M. S., Pineda Alvarez, D. E. (2011). Analysis of genitourinary anomalies in patients with VACTERL (Vertebral anomalies, Anal atresia, Cardiac malformations, Tracheo Esophageal fistula, Renal anomalies, Limb abnormalities) association. Congenital Anomalies, vol. 51, no. 2, pp. 87–91.

[13] Panjabi, M. M., Duranceau, J., Goel, V., et al. (1991). Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine, vol. 16, no. 8, pp. 861–869.

[14] Tan, S., Teo, E., and Chua, H. (2004). Quantitative three-dimensional anatomy of cervical, thoracic and lumbar vertebrae of Chinese Singaporeans. European Spine Journal, vol. 13, no. 2, pp. 137–146.

[15] Doherty, B. J. and Heggeness, M. H. (1995). Quantitative anatomy of the second cervical vertebra. Spine, vol. 20, no. 5, pp. 513–517.

[16] Greiner, T. M. (2017). Shape analysis of the cervical spinous process. Clinical Anatomy, vol. 30, no. 7, pp. 894–900.

[17] Oh, S.-H., Perin, N. I., and Cooper, P. R. (1996). Quantitative three-dimensional anatomy of the subaxial cervical spine. Implication for anterior spinal surgery. Neurosurgery, vol. 38, no. 6, pp. 1139–1144.

[18] Moore, K. L., Persaud, T. V. N., and Torchia, M. G. (2018). The developing human-ebook: clinically oriented embryology. Amsterdam, The Netherlands: Elsevier Health Sciences.

[19] Chaturvedi, A., Klionsky, N. B., Nadarajah, U., et al. (2018). Malformed vertebrae: A clinical and imaging review. Insights into Imaging, vol. 9, no. 3, pp. 343–355.

[20] Ravikanth, R. and Pottangadi, R. (2018). Nonunited secondary ossification centers of the spinous processes of vertebrae at multiple levels presenting as aberrant articulations in an adult. Journal of Craniovertebral Junction & Spine, vol. 9, no. 3, pp. 216–217.

[21] Bazaldúa, C., González, L., Gómez, S., et al. (2011). Morphometric study of cervical vertebrae C3-C7 in a population from northeastern Mexico. International Journal of Morphology, vol. 29, no. 2, pp. 325–330.

[22] Cho, W., Maeda, T., Park, Y., et al. (2012). The incidence of bifid C7 spinous processes. Global Spine Journal, vol. 2, no. 2, pp. 99–103.

[23] Tubbs, R. S., Shoja, M. M., and Loukas, M. (2016). Bergman’s comprehensive encyclopedia of human anatomic variation. Hoboken, NJ: John Wiley & Sons.