Bipartite atlas in a collegiate football player - Not necessarily a contraindication for return-to-play: A case report and review of the literature

Background: Congenital malformations of the posterior arch of the atlas are rare, occurring in 4% of the population. Anterior arch aplasia is extremely rare and often only coexists with posterior arch anomalies, resulting in a split or bipartite atlas. This congenital anomaly is believed to be present in only 0.1% of the population.

Case description: A 19-year-old male collegiate football player presented with neck pain and upper extremity paresthesias after sustaining a tackle that forced neck hyperextension. Computed tomography revealed significant congenital bony anomalies of the cervical spine, with incomplete fusion of the anterior and posterior arches of the atlas; however, there was no evidence for of any acute traumatic injury or fracture. Magnetic resonance imaging revealed increased edema in pre-vertebral soft tissues around C1-C2, with a possible increase in signal within the fibrous ring of the anterior C1 ring. Flexion and extension imaging confirmed reduced range of motion and no instability. Patient was treated non-operatively, and was able to resume normal activity and training regimens, and continued to do well clinically.

Conclusion: We describe a rare case of split or bipartite atlas in collegiate football athlete who sustained a neck injury during a tackle. The patient had no atlanto-axial instability or other clinical contraindications and was managed non-operatively, resuming full participation shortly thereafter with a full resolution of symptoms.