Surgical treatment for an uncommon headache: A gap of 4800 years

Background Surgical management of headache due to anomalies in the cervical spine is uncommon, as most cases improve with drugs and/or physical therapy. Case We report two instances of a very uncommon congenital upper cervical spine anomaly due to the presence of a pseudoarthrosis between a unilateral paracondylar process in the base of the skull and an epitransverse process arising from the transverse apophysis (PCP/ETA). The first one corresponds to a male on whom an endoscopic guided puncture was performed, and the second to an adult male from the Neolithic period who showed two cranial trepanations together with the presence of morphine metabolites in both bones and dental calculus. Discussion We draw a parallel between the treatment of two individuals separated by a gap of more than 4800 years: contemporary direct vision of the false joint through a small endoscope, which provides an accurate puncture, and ancient double trepanation with clear signs of bone eburnation.

A boy with torticollis caused by a high cervical spine anomaly

SummaryThe structural abnormalities of the cervical spine can be a cause of torticollis. Congenital cervical spine anomalies are a rare cause of torticollis in young children. Because a high cervical anomaly confers increased risk of instability and spinal cord encroachment, early detection of the anomaly is essential to avoid potentially harmful physical therapy and to provide an opportunity to initiate an adequate therapeutic plan. Here we report an interesting case of torticollis. A 5-year-old boy presented to our clinic for further assessment of torticollis. Radiologic examination revealed an extra hemi-vertebra on the right side between C1 and C2 and also a C4 butterfly vertebra with concurrent rib anomaly. In this report, we describe his clinical manifestations with a brief review of cervical spine anomalies resulting in torticollis reported in the literature.