Mahmoud Mohamed Elmalky, Sherief Elsayed, George Arealis, Hossein Mehdian

June 2013, Volume 22, Issue 6, pp 1223 - 1226 Grand Rounds Read Full Article 10.1007/s00586-013-2682-z

First Online: 12 March 2013

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We present an uncommon and yet interesting congenital anomaly and discuss the difficulties with diagnosis and controversies in management. C1 arch deficiency is an important consideration in the differential diagnosis of neck pain in children.

Material and methods

A 12-year-old girl presented initially with a loud clicking emanating from the cervical spine during nappy changes in early childhood. Subsequent investigation by way of CT and MRI revealed her to have a deficient posterior arch of the C1 vertebra, and due to persistent and painful clicking she was placed into a cervical brace, which was worn for approximately 1 year. At age 12, her clicking had all but completely resolved but she continued to complain of minor neck pain. She is advised to avoid contact sports and her parents are instructed to observe any new worrying symptoms.


No definitive guidelines exist for the management of this congenital anomaly. Indications for surgical intervention prior to any neurological disturbance are unclear, and restricting a child from partaking in healthy activity may not be necessary. We discuss the anomaly and identified management strategies as reported in the literature so far.

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