Original article: Series of vertebral synostosis-clinically implied Dr. Somanath Deepa, Dr. Rajasekar SS Department of Anatomy, Sri Manakula Vinayagar Medical College and Hospital, Puducherry (U.T.), India. Corresponding author: Dr. Somanath Deepa Date of submission: 27 June 2014 ; Date of Publication: 18 October 2014 Abstract Introduction: During the formation of vertebral column, in the fourth week of intrauterine life the sclerotome part of somites migrate around the notochord and the neural tube and undergo a process called resegmentation. Any defect in such a process can lead to vertebral anomalies causing neurological and vascular deficits. But fusion of can be congenital or acquired. Acquired fusion of can be due to diseases such as Tuberculosis, Juvenile rheumatoid arthritis and trauma. Fusion of can lead to compression, distortion of the neural structures and interference with muscular movements as well as cerebrospinal fluid channels.the present study was conducted to find out the incidence of fusion of at different levels. Materials and Methods: The current study was done on 50 dry adult vertebral columns obtained from the Department of Anatomy, Sri Manakula Vinayagar Medical College, Pondicherry. The bones were observed for fusion at the level of body, transverse process, lamina and spinous process. Results: The results are reported in a tabular format. In the cervical region two typical were fused. In the thoracic region, two typical thoracic were fused and T11 and T12 were fused. In the lumbar region, two typical lumbar were fused. There were two sacralisations of lumbar. Discussion: An intense knowledge on the occurrence of veretebral synostosis is essential to interpret varied forms of clinical presentations through relevant physical examination. It has to be borne in mind that the anomalies could be congenital or acquired. Based upon the inference, the treatment could be carried on a righteous and justified path. Key words: Somite, synostosis, vertebral anomaly, spinal fusion Introduction: The vertebral column not only process called resegmentation. This leads to the functions as a support to the body, it also acts as a formation of definitive vertebra being derived pathway for the spinal cord. Therefore for the from adjacent sclerotomes. Any defect in the spinal cord to work efficiently it is mandatory that above process can lead to one or more congenital the vertebral column follows a normal pathway of vertebral anomalies like Klippel-Feil sequence development. Development of the spine occurs (Brevicollis), spina bifida, abnormal spinal through a number of complex steps which involve curvatures like scoliosis etc. which can cause the genes, signalling pathways and many neurological and vascular deficits. But these metabolic processes. Somites are derived from deficits can also be acquired due to tuberculosis paraxial mesoderm of intraembryonic mesoderm. of spine, arthritis, trauma etc. fusion of Sclerotome parts of the somites give rise to the can lead to compression and distortion of the. Migartion of sclerotome cells around neural structures and cerebrospinal fluid channels neural tube and notochord occur during the fourth [1, 2]. It can also lead to interference with muscular week of intrauterine life. In due course, the movements, spinal deformities,less mobile pelvis sclerotome part of each somite undergoes a leading to painful and obstructed labour [ 3]. 36
The present study was conducted to find out the incidence of fusion of at different levels. Materials and Methods: The current study was conducted on 50 South Indian, dry, adult vertebral columns obtained from the Department of Anatomy, Sri Manakula Vinayagar Medical College, Pondicherry. The of all the regions were inspected to find if there exists any abnormal fusion between adjacent vertebral bodies, pedicles, laminae, spines or transverse processes. Inclusion criteria: All intact adult dry were included. Exclusion criteria: Broken, damaged and neonatal bones were excluded Results: Results are reported in a tabular format. Table 1: Showing incidence of fusion in a total of 50 vertebral columns Location of fusion Number of fusions between 2 vetebrae at given level Percentage Fusion between typical cervical 1 2% Fusion between typical thoracic 1 2% Fusion between T11 and T12 1 2% Fusion between typical lumbar 1 2% Fusion between last lumbar and 1 st sacral 2 4% Cervical Vertebral Synostosis : Two typical cervical were fused showing complete fusion of both the bodies, fusion of transverse processes on the right side and fusion of laminae on the right side. Thoracic Vertebral Synostosis was seen at two levels: 1. Fusion of two typical thoracic showing fusion of their bodies only on left side. 2. Fusion of T11 and T12 wherein bodies were fused incompletely on right and left sides. Lumbar Vertebral Synostosis: Two typical lumbar were found to be fused between the bodies on the right side. Lumbosacral Vertebral Synostosis: 1. Complete fusion of last lumbar vertebra with sacrum 2. Incomplete (unilateral)fusion of last lumbar vertebra with sacrum on the left side. Discussion: Various studies have been done to record the incidence of vertebral anomalies and it is not uncommon to find such variations not only in dry bones but also in clinical cases. A spectrum of vertebral synostosis in cervical, thoracic, lumbar regions in dry bones was reported and it was speculated that it could have been a case of Klippel-Feil Syndrome [4] suggesting that such variations if identified early can indicate the presence of congenital defects. In one study axis vertebra was fused with the 3rd cervical vertebra 37 36
with complete fusion of vertebral body, arches and spine which could have resulted in interference with neck movement, or muscular weakness, atrophy and neurological sensory loss [5]. In a study by Kubavat sacralisation of fifth lumbar vertebra was seen in 21 (11.1 %)cases and lumbarisation of first sacral vertebra was seen in 3 (1.3%). The author speculated that these anomalies can be a cause of low backache, less mobile pelvis in females leading to difficult labour [6]. Fusion between the typical thoracic and lumbar were reported by Vadgaonkar et al [7] which can cause low back ache. A case of congenital abnormal cervical with two typical cervical vertebral laminae fused on left side along with the failure of development of pedicle, costal element and anterior tubercle of transverse process of lower cervical was reported by Tiwari et al [8]. Five clinical cases of congenital fusion of cervical were observed by Erdil et al which could be due to defect in the development of the occipital and cervical somites [9]. A study by Yogesh et al. has noted that cervical vertebral synostosis can lead to severe neck pain, muscular weakness and sensory involvement of bilateral upper limbs and even sudden unexpected death [10]. The findings of the present study coincide with a study by Sharma et al. which also conclude that vertebral fusion (block vertebra) is most commonly seen in the lumbo sacral region than in any other region [11]. Conclusion: Synostosis of can be congenital or acquired. The observations in this study have to be kept in mind while dealing with clinical cases, because it is not uncommon to come across conditions which are basically caused by such vertebral anomalies, like muscular weakness, restriction of movements, sensory involvement, obstructed labour and many others depending on the area of involvement. If similar variations are identified as early as possible, morbidity and mortality due to the afore mentioned clinical conditions can be reduced. The present study was done in a small sample size. However, the incidence of vertebral synostosis may be higher if the study is done in a larger sample size. Acknowledgements: I express my sincere gratitude to Dr.Shivali Srivastava for her constant support throughout this work. I am thankful to Sri Manakula Vinayagar Medical College for their kind consent to use the materials. Conflict of interest: Conflict of interest none to declare. Medworld asia Dedicated for quality research www.medworldasia.com 37 38
Figure 1: showing fusion between 2 typical cervical Figure 2: showing fusion between 2 typical thoracic Figure 3: showing fusion between T11 and T12 Figure 4: showing fusion between 2 typical lumbar Figure 5: showing complete sacralisation of last lumbar vertebra Figure 6: showing incomplete sacralisation of last lumbar vertebra References: 1. Ranade AV, Rai R, Prabhu LV, Kumaran M, Pai MM. Atlas Assimilation: A Case Report. Neuroanatomy 2007; 6(1): 32-3. 2. Mudaliar RP, Shetty S, Nanjundaiah K, KumarP, Jyothi KC. An Osteological Study of Occipitocervical Synostosis: Its Embryological and Clinical Significance. Journal of Clinical and Diagnostic Research 2013 Sep; 7(9): 1835-7. 3. Saini V, Singh R, Bandopadhyay M, Tripathi SK, Narayan S, Shamal. Occipitilisation of the atlas; its occurrence and embryological basis. International Journal of Anatomical Variation 2009; 2(1): 65 8. 4. Kulkarni V, Ramesh BR. A Spectrum Of Vertebral Synostosis. International Journal of Basic and Applied Medical Sciences 2012; 2 (2):71-7. 37 39
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