Anatomic, functional, and radiographic review of the ligaments of the craniocervical junction

Fiester, Peter; Rao, Dinesh; Soule, Erik; Orallo, Peaches; Rahmathulla, Gazanfar

doi:10.4103/jcvjs.jcvjs_209_20

Cited by 18 publications

(9 citation statements)

References 25 publications

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“…10 Despite the potential diagnostic gain by extended imaging, choosing the correct metrics and advanced knowledge of the 3-dimensional plane, as well as their pathophysiological and mechanical alterations caused by EDS, are indispensable areas of expertise for each radiologist involved in the diagnostics of EDS-related CCI. [32][33][34] In this context, a cross linkage to patients with Down syndrome, who often present with CCI, could reveal significant knowledge about the anatomical and biomechanical effects of ligamentous laxity and subsequent instability. 35 A recent study assessed predictors for neurological deficits in Down patients with CCI after using dynamic MRI of the cranio-cervical junction.…”

Section: Discussionmentioning

confidence: 99%

Craniocervical Instability in Ehlers-Danlos Syndrome—A Systematic Review of Diagnostic and Surgical Treatment Criteria

Lohkamp

Marathe

Fehlings

2022

Global Spine Journal

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Study Design Systematic review. Objective Ehlers-Danlos Syndrome (EDS) comprises a spectrum of connective tissue disorders, which may be associated with cranio-cervical instability (CCI). There is a lack of consensus on diagnostic imaging parameters, indications, and outcomes of surgical treatment. Methods This systematic review analyses the literature on diagnostic methods and/or criteria for CCI, screening the databases Ovid Medline, Embase, Cochrane Library, and PubMed. Articles were included based on the PRISMA guidelines and assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS) and according to their evidence level. Results Sixteen articles, including 78 surgical patients, met the inclusion criteria. The main diagnostic measures for CCI were dynamic x-rays and CT imaging. Ten different radiographic parameters were reported, of which 4 were the most frequently applied for surgical decision-making: the clivo-axial angle (CXA), the Harris measurement, the Grabb–Mapstone–Oakes measurement, and the angular displacement of C1 to C2. The evidence level ranged between III and V and the article quality between 4 and 8 out of 9 stars on the NOS Scale. Conclusions There is a lack of high quality, prospective evidence regarding the evaluation of suspected CCI in patients with EDS. Based on our systematic review, we recommend that the CXA, Harris measurement, Grabb–Mapstone–Oakes measurement, and the angular displacement of C1 to C2 be used to evaluate suspected CCI in EDS patients. Surgical fixation of suspected CCI should only be performed in cases with clear radiographic presence of instability and concordant symptoms/signs. Consensus-based guidelines and care pathways are required.

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Section: Discussionmentioning

confidence: 99%

Craniocervical Instability in Ehlers-Danlos Syndrome—A Systematic Review of Diagnostic and Surgical Treatment Criteria

Lohkamp

Marathe

Fehlings

2022

Global Spine Journal

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“…The transverse ligament is 6 to 7 mm in height and connects the dorsal aspect of the odontoid process with a tubercle arising from the inner aspect of each lateral mass of the atlas. 2,3,6 It allows rotation at the atlantoaxial joint, serving as one of the primary stabilizers of the CCJ.…”

Section: Internal Ligamentsmentioning

confidence: 99%

Imaging of the Craniocervical Junction: A Pictorial Review

Mertens,

Vanhoenacker

2023

Semin Musculoskelet Radiol

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The craniocervical junction (CCJ) is a complex anatomical structure comprising the occiput, the atlas, and the axis. The CCJ plays an important role in maintaining stability, providing protection, and supporting neurovascular structures. The CCJ can be affected by a wide range of congenital variants and traumatic, degenerative, inflammatory, and tumoral pathologies. This pictorial review the normal anatomy of the CCJ and presents the most common anatomical variants and pathologic conditions affecting the CCJ.

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“…Within these fibers is a small defect where the vertebral artery runs through. 27 Unlike the AAOM, the PAOM consequently prevents hyperflexion and impingement of the atlas on the cervicomedullary junction. The PAOM is best seen on sagittal images on MRI.…”

Section: Posterior Atlanto-occipital Membranementioning

confidence: 99%

Imaging in Whiplash-Associated Disorders

Schollaert,

Van Goethem

2023

Semin Musculoskelet Radiol

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Abstract“Whiplash,” a term describing the severe acceleration and deceleration forces applied to the head, craniocervical junction (CCJ), and cervical spine during trauma, is one of the most frequent mechanisms of injury to the CCJ. The CCJ is a complex region at the transition of the cranium and the cervical spine, essential for maintaining craniocervical stability. In whiplash injuries, the CCJ may be compromised due to underlying ligamentous or, less frequently, osseous, intravertebral disk and/or muscular lesions. Imaging is crucial in detecting acute lesions but may also play a role in the follow-up of chronic pathology because soft tissue lesions and progressive disk pathology could contribute to a whiplash-associated disorder.

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Anatomic, functional, and radiographic review of the ligaments of the craniocervical junction

Cited by 18 publications

References 25 publications

Craniocervical Instability in Ehlers-Danlos Syndrome—A Systematic Review of Diagnostic and Surgical Treatment Criteria

Craniocervical Instability in Ehlers-Danlos Syndrome—A Systematic Review of Diagnostic and Surgical Treatment Criteria

Imaging of the Craniocervical Junction: A Pictorial Review

Imaging in Whiplash-Associated Disorders

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