Evaluation of lateral atlantodental interval asymmetry in the pediatric age group: normative values

Mendenhall, Stephen K.; Huh, Andrew; Pandya, Janit; Alentado, Vincent J.; Balsara, Karl; Ho, Chang Kyoung; Jea, Andrew

doi:10.3171/2018.2.peds17694

Cited by 4 publications

(1 citation statement)

References 24 publications

(24 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…evaluated 540 pediatric non-trauma cervical CT exams and found a mean difference in right and left lateral ADI as .09 +/− 1.23 mm with maximal asymmetry of 4.87 mm. 25 In our 27 patient cohort with TAL injury on cervical MRI, only 14% of patients demonstrated a lateral ADI greater than 2 mm with a maximum lateral ADI of 4 mm in one patient; hence, our findings suggest no measurable difference in lateral ADI between non-trauma patients and those with TAL injuries ( Figure 5 ). Although no known normative values for C1 lateral mass offset have been established on cervical CT, combined C1 LMO greater than 6.9 mm in the setting of a C1 ring fracture—known as the “Rule of Spence”—is still used to help predict TAL injury; however, more recent research studies using cervical MRI have found that this criteria drastically underestimates associated TAL injuries.…”

Section: Discussionmentioning

confidence: 57%

Utility of Anterior Atlantodens Interval Widening on Cervical Spine CT for Assessing Transverse Atlantal Ligament Injury

Fiester

Orallo

Soule

et al. 2022

Global Spine Journal

View full text Add to dashboard Cite

Study Design Retrospective, cross-sectional Objectives To identify trauma patients with confirmed tears of the transverse atlantal ligament on cervical MRI and measure several parameters of atlanto-axial alignment on cervical CT, including the anterior atlantodens interval, to determine which method is most sensitive in predicting transverse atlantal ligament injury. Methods Adult trauma patients who suffered a transverse atlantal ligament tear on cervical MRI were identified retrospectively. The cervical CT and MRI exams for these patients were reviewed for the following: anterior and lateral atlantodens interval widening, lateral C1 mass offset, C1–C2 rotatory subluxation, and transverse atlantal ligament injuries on cervical MRI. Results Twenty-six patients were identified with a tear of the transverse atlantal ligament on cervical MRI. Twelve percent of these patients demonstrated an anterior dens interval measuring greater than 2 mm, 26% of patients demonstrated lateral mass offset of C1 on C2 (average offset of 2.4 mm), 18% of patients demonstrated an asymmetry greater than 1 mm between the left and right lateral atlantodens interval, and one patient demonstrated atlanto-axial rotation measuring greater than 20%. Ten patients had an accompanying C1 burst fracture and eight patients had a C2 fracture. One patient demonstrated widening of the atlanto-occipital joint space greater than 2 mm indicative of craniocervical dissociation injury. Conclusions An anterior atlantodens interval measuring greater than 2 mm is an unreliable methodology to screen trauma patients for transverse altantal ligament injuries and atlanto-axial instability. Moreover, C1 lateral mass offset, lateral atlantodens asymmetry, and atlanto-axial rotation were all poor predictors of transverse atlantal ligament tears.

show abstract

Section: Discussionmentioning

confidence: 57%