Finger-shaped sesamoid bones aligned within the nuchal ligament

Accepted Manuscript Title: Finger-shaped sesamoid bones aligned within the nuchal ligament Author: Yalçın Bozkurt, Engin Ilker Çiçek, Hatice Tuba Sanal, Alparslan Bayram Çarli PII: DOI: Reference:

S1529-9430(16)30019-5 http://dx.doi.org/doi: 10.1016/j.spinee.2016.03.049 SPINEE 56993

To appear in:

The Spine Journal

Please cite this article as: Yalçın Bozkurt, Engin Ilker Çiçek, Hatice Tuba Sanal, Alparslan Bayram Çarli, Finger-shaped sesamoid bones aligned within the nuchal ligament, The Spine Journal (2016), http://dx.doi.org/doi: 10.1016/j.spinee.2016.03.049. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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FINGER-SHAPED SESAMOID BONES ALIGNED WITHIN THE NUCHAL

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LIGAMENT

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Yalçın BOZKURT, MD

Engin Ilker ÇIÇEK, MD

Hatice Tuba SANAL, MD, Associate Professor

Alparslan Bayram ÇARLI, MD, Assistant Professor

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Gölcük Military Hospital, Departments of 1Radiology, 2Orthopedic Surgery, Kocaeli, Turkey 3

Gülhane Military Medical Academy, Department of Radiology, Ankara, Turkey

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and 4 Gülhane Military Medical Academy, Haydarpaşa Training Hospital, Department of

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Physical Medicine and Rehabilitation, Istanbul, Turkey

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Conflict of Interest: None

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Correspondence:

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Dr. Alparslan Bayram ÇARLI

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Address: Gülhane Askeri Tıp Akademisi Haydarpaşa Eğitim Hastanesi, Fiziksel Tıp ve Rehabilitasyon Servisi, Üsküdar 34010 Istanbul, Turkey

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Tel: +90 216 542 20 20 Fax: +90 216 542 20 20

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E-mail: [email protected]

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Keywords: cervical spine, nuchal ligament, sesamoid, ossicles, calcification, finger shaped

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A 66-year-old man was due to his complaints of neck pain after he fell down in his apartment

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two days ago. On physical examination, local tenderness at the posterior aspect of the neck

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from the level C2 to T2 was noted. No ecchymosis or hematoma was detected. Minimal

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restriction on flexion and rotations of cervical column was observed. Neurologic

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examinations were normal. Lateral view X-ray and axial spiral tomography of the cervical

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spine showed three supernumerary ossicles aligned within the nuchal ligament at the level of

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C4-C6 vertebral spinous processes. All ossicles had smooth borders and arranged in an order

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so that they were giving a configuration of a “finger” (Figure 1-2). Examples of sesamoid

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bone in the nuchal ligament of the axial skeleton are usually small ovoid or round ossicles

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[1,2]. In this case, the patient’s pain resolved with rest, physical therapy and non-steroidal

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anti-inflammatory drugs.

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References:

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[1] Çarlı AB, Kaya E, Turgut H, Sağlam M. Sesamoid ossicle of the nuchal ligament.

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Spine J. 2014;14(5):852.

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[2] Yuce I, Pirimoglu B, Polat G, Sade R, Emet M, Kantarci M. A sesamoid ossicle of

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the nuchal ligament mimicking spinous avulsion fracture. Spine J. 2015;16(2): e39.

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Figure Legends:

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Figure 1:

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Lateral cervical spine radiograph; finger-shaped aligned three sesamoid bones (arrow) are

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seen at the level of C4-C6.

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Figure 2:

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Axial neck tomography; nuchal ligament (arrow), and a sesamoid bone (thick arrow) are seen.

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