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Make no bones about it!

HOW MANY bones does your body have? If you say ?205?, you are one short of the magic figure of 206, considered standard for most adults. As for the missing bone, you can blame it on the ?Craniovertebral Junction Anomaly.? It is a rare congenital deformity among humans who live absolutely normal lives, even though the first bone in their vertebrae is absent. They rarely come to know about the missing bone.

india Updated: Apr 07, 2006 01:04 IST

HOW MANY bones does your body have? If you say ‘205’, you are one short of the magic figure of 206, considered standard for most adults.

As for the missing bone, you can blame it on the ‘Craniovertebral Junction Anomaly.’ It is a rare congenital deformity among humans who live absolutely normal lives, even though the first bone in their vertebrae is absent.
They rarely come to know about the missing bone.

The anatomy of the vertebrae has a unique combination made of C1, the first vertebrae bone (atlas), and C2, the second bone (axis), with the human skull.
The head rotates on a combination of the atlas and the axis. This happens when a rodlike bone ‘dens,’ which is joined to the axis, passes through the atlas, to hold the skull in one position. The skull thus rotates free in ‘X’ and ‘Y’ directions.
The atlas does not have a spinous process, or body, but it consists of anterior and posterior arches, each of which has a tubercle and a lateral mass.

The reason that atlas and axis vertebrae are so atypical is that part of the body of the atlas (dens) is incorporated into the body of the axis. The axis is the strongest of the cervical vertebrae, because the atlas carrying the skull rotates on it. The part of the body that remains with the atlas is represented by an anterior arch.

Deformity is usually congenital, as the atlas is absent in some of us.
“Nature has brought about this deformity beautifully, as it settles the skull on the axis. The rotation is normal even without the atlas. But, a problem arises when the dens goes deep in to the skull causing severe pain,” says Dr OP Singh, senior orthopaedic surgeon at the King George’s Medical University.

The pain is initially managed through medication, but in rarest of the rare cases, the patient needs to undergo surgery. “

Every day patients come with pain in CV Junction and in five per cent cases, we find the atlas missing.

This is because not every patient requires a Magnetic Resonance Imaging to diagnose the reasons for pain,” says Dr Vinod Tiwari of NOVA Hospital.

Patients, who are suspected to have a tumour in the neck region, or those who get no pain relief despite medication, go in for an MRI of the neck region.
It is among these five per cent cases that the absence of the atlas is noticed.
Mostly, patients from eastern UP are diagnosed with a missing bone, but the exact number is not recorded, Dr Tiwari says.

First Published: Apr 07, 2006 01:04 IST