Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

Roy, Anil K.; Miller, Brandon A.; Holland, Christopher M.; Fountain, Arthur J.; Pradilla, Gustavo; Ahmad, Faiz U.

doi:10.3171/2015.1.focus14785

Cited by 22 publications

(13 citation statements)

References 44 publications

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“…Several studies have revealed issues with the reliability of image interpretation, as well as technical difficulties with patient positioning and image acquisition when performing these sequences [8,9,[11][12][13]33]. Lastly, this imaging technique may be inaccurate unless optimal technique is employed, necessitating expertise by involved staff [11,13,26]. These conflicting data highlight the need to investigate complementary imaging techniques which may reveal occult CCJ injury; additional methods of dynamic radiography, as described in this study, may provide that complement.…”

Section: Discussionmentioning

confidence: 95%

“…The authors concluded that abnormal imaging findings did not correlate with symptoms and that there was no evidence to support the assertion that MRI reveals ligamentous injury in this patient population. Several studies have revealed issues with the reliability of image interpretation, as well as technical difficulties with patient positioning and image acquisition when performing these sequences [8,9,[11][12][13]33]. Lastly, this imaging technique may be inaccurate unless optimal technique is employed, necessitating expertise by involved staff [11,13,26].…”

Section: Discussionmentioning

confidence: 99%

“…CT or magnetic resonance imaging (MRI) may demonstrate articular subluxation or directly visualize ligamentous injury [5][6][7]. There are concerns however, surrounding technical considerations and the reliability of these tools [8][9][10][11][12][13]. Given that injury to the cranio-cervical junction (CCJ) may lead to chronic symptoms following trauma, the role of CCJ injury is gaining greater recognition in non-responders to initial management of common injuries such as concussion and whiplash [5,6,8,9,14].…”

Section: Introductionmentioning

confidence: 99%

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Inter-examiner reliability of radiographic measurements from Open-mouth lateral bending cervical radiographs

et al. 2020

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Background: Following head and neck trauma, the involvement of the cranio-cervical junction (CCJ) and its contribution to a patients transition to chronic pain, is poorly understood. The detection of hypermobility in this region is dependent on clinical examination and static imaging modalities such as x-ray, CT and MRI. Sagittal plane hypermobility of the CCJ is evaluated using saggital view, flexion-extension cervical radiographs. Frontal plane hypermobility is typically assessed using lateral bending and open mouth cervical radiographs. Unfortunately there is no established reliability surrounding the use of these measures. This study explores the reliability of radiographic measurements of lateral-bending open-mouth cervical radiographs. Methods: Cervical open-mouth lateral-bending X-ray images were collected from 56 different patients between 18 and 60 years of age patients following cervical spine injury. These images were interpreted by two musculoskeletal radiologists and two clinicians (physiatrist and chiropractor), using a standard set of measurements. Measurements included qualitative and quantitative assessments of the amount of asymmetry noted between various osseous landmarks. Reliability statistics were calculated for levels of agreement using kappa coefficients (κ) and Intraclass Correlation Coefficients (ICC) for dichotomous and continuous variables, respectively. Results: Reliability (κ) for qualitative assessments were moderate to substantial for asymmetry of neutral C2 spinous position, dens-lateral mass spacing, and "step off" between the lateral borders of the articular pillars of C2 and C1 lateral mass (κ range = .47-.78). ICC values for the quantitative measurements of dens-lateral mass spacing and "step off" between the lateral borders of the C2 articular pillars and C1 lateral mass were moderate to excellent (ICC range = .56-.97). Conclusions: The qualitative and quantitative measurements used in this study demonstrated good to excellent inter-examiner reliability. Correlation with clinical findings is necessary to establish the utility of these measurements in clinical practice.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Inter-examiner reliability of radiographic measurements from Open-mouth lateral bending cervical radiographs

et al. 2020

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“…Emergent spine CT as part of the initial advanced trauma life support (ATLS) evaluation has been shown to be much more reliable than standard radiographs to evaluate fractures and joint displacement [15, 16]. MRI may also be necessary to evaluate integrity of the soft tissues, spinal cord, or brainstem [4, 17]. MRI is especially critical in determining the integrity of the major ligamentous structures of craniocervical junction including the tectorial membrane, occipitocervical joint capsules, alar ligaments, and transverse ligament [7, 18].…”

Section: Discussionmentioning

confidence: 99%

Occipitocervical Dislocation in Low-Energy Trauma

Tavolaro

Bransford

Yerrapragada

et al. 2018

Case Reports in Orthopedics

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Traumatic occipitocervical dislocation (OCD) is described in the literature as a potentially fatal injury secondary to high-energy trauma. We describe a case of OCD occurring in a patient who sustained a ground-level fall whose only clinical symptom was posterior neck pain without neurologic compromise. Computed tomography (CT) and magnetic resonance imaging (MRI) were used to diagnose severe injury to the structurally important ligamentous complex that stabilizes the base of the skull to the spine, along with unstable fractures of the occipital condyle and C1. Emergent surgical instrumentation and fusion of occiput-C2 was performed. Postoperatively, neurologic integrity was maintained. This case illustrates that traumatic OCD is not exclusively secondary to high-energy mechanisms. It also demonstrates that severe neck pain as the only clinical manifestation in a patient with head or neck low-energy trauma is suggestive of a possible OCD. We highlight the importance of the use of head and neck CT as the first imaging-based diagnostic tool to aid in identifying this injury. Finally, surgical stabilization should be performed as soon as possible to minimize neurologic sequelae.

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“…This region is embryologically, anatomically, and biomechanically different from the other cervical region. [ 1 2 3 4 5 6 ]…”

Section: Introductionmentioning

confidence: 99%

Management of occipitocervical junction and upper cervical trauma

Dağtekin

Avcı

Hamzaoğlu

et al. 2018

J Craniovert Jun Spine

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Objective:The treatment modality of occipitocervical junction (OCJ) and upper cervical traumas carries great importance because of unique form of bone, complex ligamentous, and neurovascular structure.Materials and Methods:Eighty-eight patients were admitted to Mersin University Department of Neurosurgery between January 2007 and January 2017 for injuries of the OCJ and upper cervical spine and evaluated retrospectively. In the group, there were 60 male, 28 female patients in the mean age of 42.9 (18–87) years. Among those, 2 occipital condyle fractures, 28 C1 fractures (26 isolated and 2 with transverse ligament injury), 9 combined C1/C2 fractures, 6 rotatory C1/C2 dislocations, and 43 C2 fractures (32 odontoid, 5 Hangman's, and 6 miscellaneous fractures) were diagnosed. In addition to clinical cases, ten cadavers were used to study the OCJ in a step-wise manner.Results:Occipital condyle fractures, isolated C1 fractures, and rotatory C1/C2 dislocations were treated conservatively. Two patients with C1 fracture including transverse ligament injury were operated in one of the methods of C1–C2 fusion which is posterior sublaminar wiring. Five patients having Type II odontoid fracture were treated surgically. One instable Hangman's fracture patient was treated as anterior cervical discectomy and fusion.Conclusions:Cases with isolated C1 fracture with intact transverse ligament should be conservatively treated without surgical approach. Atlas fractures with transverse ligament rupture, odontoid Type II fractures with dislocation >6 mm, and unstable Hangman's fractures required surgical treatment. Vital neurovascular, ligamentous, and accompanying bone structures should be evaluated for diagnosis and treatment modality. In addition, patient's health status, patient's treatment preference, and surgical team experience are the affecting factors for the decision of surgery.

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Magnetic resonance imaging of traumatic injury to the craniovertebral junction: a case-based review

Cited by 22 publications

References 44 publications

Inter-examiner reliability of radiographic measurements from Open-mouth lateral bending cervical radiographs

Inter-examiner reliability of radiographic measurements from Open-mouth lateral bending cervical radiographs

Occipitocervical Dislocation in Low-Energy Trauma

Management of occipitocervical junction and upper cervical trauma

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