Traumatic injuries to the craniovertebral junction: a review of rare events

Abstract

The craniovertebral junction is a specific region of the spine with unique anatomical and biomechanical properties that yields a wide variety of injury patterns. Junctional traumatic fractures and/or dislocations are widely reported in clinical practice, but we could identify only a subgroup of upper cervical spine traumatic injuries with very few cases reported in the literature, and for this reason may be considered rare. In some of these cases, the absence of spinal biomechanical instability, in association with moderate clinical symptoms (neck stiffness and pain) and the difficulty in fracture identification through standard cervical radiographs, leads to a high percentage of missed injuries. In other cases, traumatic events have been commonly described only in autopsy series due to the high degree of spinal biomechanical instability. Herein, we have summarized all the relevant literature concerning this issue and also included our cases, with the aim of emphasizing prompt diagnosis and correct management. We provide a guide for correctly identifying "rare" craniovertebral junction traumatic injuries.

Management of post-traumatic craniovertebral junction dislocation: A PRISMA-compliant systematic review and meta-analysis of casereports

“…Fortunately, as we presented, successful stabilization paired with further rehabilitation can mitigate it better than in cases of other CVJ abnormalities. Importantly, as Debernardi noticed, if neck pain and stiffness are mild to moderate, it is more likely to overlook the diagnosis [ 53 ].…”

Clinical and Radiological Clues of Traumatic Craniocervical Junction Injuries Requiring Occipitocervical Fusion to Early Diagnosis

“…29 Posterior OC fusion is the treatment of choice in most cases 30 and the development of plate, rod, and screw system has allowed us to attain successful outcomes without the need for postoperative halo immobilization 31,32 with high bony fusion rate of more than 90%. 31 In summary, as CCJ stability is largely dependent on ligamentous integrity, 33,34 MRI has greater sensitivity for detecting CCJ instability by analysis of disc disruption, facet injuries, and ligament injuries than CT scans or x-ray alone 1 and the addition of MRI to CT scans can alter patient management. 25,[35][36][37] The classification system where MRI findings are fully integrated needs to be developed particularly for occipitoatlantal instability.…”

Cervical Spine Trauma

“…Ligaments and membranes in CVJ injuries have often been recognized but only recently (due to magnetic resonance imaging (MRI) and the increase in the knowledge of anatomical and biomechanical characteristics in the CVJ area) their role has been highlighted. 10 Recent data emphasize the major role of the ligaments and membranes in CVJ injuries with a…”