Congenital Fusion: Radiology vs Palpation

So, your patient has a radiologically reported congenital cervical fusion.  Are you going to take this at face value? Congenital fusion: radiology vs palpation.

Can we rely on radiological examination to confirm congenital fusion of C1-2 or C2-3? Are there false positives?

Radiological examination for confirming congenital fusion of cervical vertebrae, particularly C1-2 or C2-3, can be unreliable and prone to false positives.

Research suggests that lateral views are especially problematic, often leading to incorrect diagnoses of fusion.^1-3 Visual interpretation may result in false-positive findings, necessitating growth-based superimposition or advanced imaging techniques for accurate diagnosis.²

Computed tomography is considered more precise and reliable than magnetic resonance imaging or plain radiographs when assessing the possibility of cervical fusion.⁴

The prevalence of actual cervical vertebrae anomalies/fusions(?) varies among studies, with some reporting lower incidences than previously thought.⁵ Importantly, cervical fusions may be progressive, particularly in children, which can complicate diagnosis.^5,6

Therefore, caution is advised when relying solely on radiological examination to confirm cervical vertebrae fusion.

Another caveat is that challenging the radiological appearance/report of cervical fusion requires skilled palpation; therein lies the other challenge…

References:

1. Patcas R, Tausch D, Pandis N, et al. Illusions of fusions: assessing cervical vertebral fusion on lateral cephalograms, multidetector computed tomographs, and cone-beam computed tomographs. Am J Orthod Dentofacial Orthop. Feb 2013;143(2):213-220.
2. Koletsis DD, Halazonetis DJ. Cervical vertebrae anomalies in orthodontic patients: a growth-based superimpositional approach. Eur J Orthod. Feb 2010;32(1):36-42.
3. Bebnowski D, Hänggi MP, Markic G, Roos M, Peltomäki T. Cervical vertebrae anomalies in subjects with Class II malocclusion assessed by lateral cephalogram and cone beam computed tomography. Eur J Orthod. Apr 2012;34(2):226-231.
4. Rhee JM, Chapman JR, Norvell DC, Smith J, Sherry NA, Riew KD. Radiological Determination of Postoperative Cervical Fusion: A Systematic Review. Spine (Phila Pa 1976). Jul 01 2015;40(13):974-991.
5. Anderson PJ, Hall C, Evans RD, Harkness WJ, Hayward RD, Jones BM. The cervical spine in Crouzon syndrome. Spine (Phila Pa 1976). Feb 15 1997;22(4):402-405.
6. Smith MD, Phillips WA, Hensinger RN. Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients. Spine (Phila Pa 1976). Jul 1991;16(7):695-701.