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Craniovertebral Junction Instability and Mechanisms of Injury

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Surgery of the Cranio-Vertebral Junction

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Abstract

The chapter deals with the concept of post-traumatic instability of the craniovertebral junction (CVJ). Comprehension of the normal anatomy and native biomechanics of the CVJ is essential to recognize the post-traumatic injuries and potential instability which may result into catastrophic neurological complication. Biomechanically, the cranio-cervical junction supports the weight of the head and represents one of the most mobile segment of the spine. Physiological range of motion must be understood with approximately 25–30° of flexion-extension at C0-C1 and C1-C2 and around 35–40° of rotation each side at C1-C2. The stability is ensured by both soft tissues including joint capsules, membranes and ligaments, and sub-occipital muscles with the key-role played by the transverse ligament, and also bony structures including lateral masses of C1 and C2 and the odontoid process. According to the mechanisms of injury (compression, distraction, translation, rotation), it is possible to categorize specific injury patterns that is helpful to assess the stability of the injury and may influence the treatment option. CT-scan is very effective to detect injuries of bony structures and look for abnormal displacements whereas MRI is useful to objective and confirm the presence of ligamentous lesions.

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References

  1. Anderson PA, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg Am. 1974;56:1663–74.

    Article  CAS  Google Scholar 

  2. Anderson PA, Montesano PX. Morphology and treatment of occipital condyles fractures. Spine. 1988;13:731–6.

    Article  CAS  Google Scholar 

  3. Barrey C, Charles YP, French Spine Surgery Society (SFCR). Symposium on C1-C2, based on 417 C1-C2 post-traumatic injuries. Presented at SFCR Annual Meeting. Lyon; 2016.

    Google Scholar 

  4. Benzel EC, Hart BL, Ball PA, Baldwin NG, Orrison WW, Espinosa M. Fractures of the C2 vertebral body. J Neurosurg. 1994;81:206–12.

    Article  CAS  Google Scholar 

  5. Bleys RL. Chapter 1: Anatomy of the cervical spine. In: Vialle LR, editor. Cervical spine trauma, AOspine Masters Series, vol. 5: Thieme Medical Publishers; 2015. p. 1–16.

    Google Scholar 

  6. Bogduk N, Mercer S. Biomechanics of the cervical spine I: normal kinematics. Clin Biomech. 2000;15:633–48.

    Article  CAS  Google Scholar 

  7. Crisco JJ, Oda T, Panjabi MM, Bueff HU, Dvorak J, Grob D. Transections of the C1-C2 joint capsular ligaments in the cadaveric spine. Spine. 1991;16:S474–9.

    Article  Google Scholar 

  8. Dickman CA, Greene KA, Sonntag VK. Injuries involving the transvers atlantal ligament: classification and treatment guidelines based upon experience with 39 injuries. Neurosurgery. 1996;38:44–50.

    Article  CAS  Google Scholar 

  9. Dickman CA, Crawford NR. Chapter 3: Biomechanics of the craniovertebral junction. In: Dickman CA, Spetzler RF, Sonntag VK, editors. Surgery of the craniovertebral junction: Thieme Publisher; 1998. p. 59–80.

    Google Scholar 

  10. Dickman CA, Greene KA, Sonntag VK. Chapter 8: Traumatic injuries of the craniovertebral junction. In: Dickman CA, Spetzler RF, Sonntag VK, editors. Surgery of the craniovertebral junction: Thieme Publisher; 1998. p. 175–96.

    Google Scholar 

  11. Dvorak J, Panjabi MM. Functional anatomy of the alar ligaments. Spine. 1987;12:183–9.

    Article  CAS  Google Scholar 

  12. Dvorak J. CT-functional diagnostics of the rotatory instability of upper cervical spine—part 1. An experimental study on cadavers. Spine. 1987;12:197–205.

    Article  CAS  Google Scholar 

  13. Effendi B, Roy D, Cornish B, Dussault RG, Laurin CA. Fractures of the ring of the axis. A classification based on the analysis of 131 cases. J Bone Joint Surg Br. 1981;63-B:319–27.

    Article  CAS  Google Scholar 

  14. Fielding JW, Cochran G, Lawsing J, Hohl M. Tears of the transverse ligament of the atlas. A clinical and biomechanical study. J Bone Joint Surg Am. 1974;56:1683–91.

    Article  CAS  Google Scholar 

  15. Fielding JW, Hawkins RJ. Atlantoaxial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 1977;59:37–44.

    Article  CAS  Google Scholar 

  16. Gehweiler JA, Osborne RL, Becker RF. The radiology of vertebral trauma. Philadelphia: WB Saunders; 1980.

    Google Scholar 

  17. German JW, Hart BL, Benzel EC. Nonoperative management of vertical C2 body fractures. Neurosurgery. 2005;56:516–21.

    Article  Google Scholar 

  18. Gire JD, Roberto RF, Bobinski M, Klineberg EO, Durbin-Johnson B. The utility and accuracy of computed tomography in the diagnosis of occipitocervical dissociation. Spine J. 2013;13:510–9.

    Article  Google Scholar 

  19. Ghori A, Leonard D, Cha T. Chapter 2: Biomechanics of the cervical spine: from the normal state to the injury state. In: Vialle LR, editor. Cervical spine trauma, AOspine Masters Series, vol. 5: Thieme Medical Publishers; 2015.

    Google Scholar 

  20. Goel VK, Clark CR. Moment-relationships of the ligamentous occipito-atlanto-axial complex. J Biomech. 1988;21:673–80.

    Article  CAS  Google Scholar 

  21. Goel VK. Chapter 6: Biomechanics of the unstable craniovertebral junction. In: Goel A, Cacciola F, editors. The craniovertebral junction: Thieme Publishers; 2011. p. 39–47.

    Google Scholar 

  22. Gonzalez LF, Fiorella D, Crawford NR. Vertical atlanto-axial distraction injuries: radiological criteria and clinical implications. J Neurosurg Spine. 2004;1(3):273–80.

    Article  Google Scholar 

  23. Gonzalez LF, Webb KM, Crawford NR, Sonntag VK. Chapter 32: Trauma to the craniovertebral junction. In: Goel A, Cacciola F, editors. The craniovertebral junction: Thieme Publishers; 2011. p. 338–56.

    Google Scholar 

  24. Jackson RS, Banit DM, Rhyne AL, Darden BV. Upper cervical spine injuries. J Am Acad Orthop Surg. 2002;10(4):271–80.

    Article  Google Scholar 

  25. Louis R. Chirurgie du rachis (anatomie chirurgicale et voies d’abord), french. 2e édition. Springer; 1993.

    Google Scholar 

  26. Panjabi MM, et al. Three dimensional movements of the upper cervical spine. Spine. 1988;13:726–30.

    Article  CAS  Google Scholar 

  27. Panjabi MM, Oxland TR, Parks EH. Quantitative anatomy of cervical spine ligaments. Part I. Upper cervical spine. J Spinal Disord. 1991;4(3):270–6.

    CAS  PubMed  Google Scholar 

  28. Panjabi MM. Posture affects motion coupling patterns of the upper cervical spine. J Orthop Res. 1993;11:525–36.

    Article  CAS  Google Scholar 

  29. Penning L. Normal movements of the cervical spine. AJR Am J Roentgenol. 1978;130:317–26.

    Article  CAS  Google Scholar 

  30. Puttlitz CM, Goel VK, Clark CR, traynelis VC, Scifert JL, grosland NM. Biomechanical rationale for the pathology of rheumatoid arthritis in the craniovertebral junction. Spine. 2000;25(13):1607–16.

    Article  CAS  Google Scholar 

  31. Schleicher P, Scholz M, Kandziora F. Chapter 5: Occipital condyle fractures and occipitocervical dissociation. In: Vialle LR, editor. Cervical spine trauma, AOspine Masters Series, vol. 5: Thieme Medical Publishers; 2015. p. 49–60.

    Google Scholar 

  32. Scholz M, Schleicher P, Kandziora F. Chapter 6: Atlas injuries. In: Vialle LR, editor. Cervical spine trauma, AOspine Masters Series, vol. 5: Thieme Medical Publishers; 2015. p. 61–72.

    Google Scholar 

  33. Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation. Case report. J Neurosurg. 1986;65:863–70.

    Article  CAS  Google Scholar 

  34. Watier B. Étude expérimentale du rachis cervical: comportement mécanique in vitro et cinématique in vivo [thèse]. Paris: Ensam; 1997. p. 1–184.

    Google Scholar 

  35. Watier B. Mechanical behavior of cervical spine: literature update. ITBM-RBM. 2006;27:92–106.

    Article  Google Scholar 

  36. Wen N. Contribution à l’étude expérimentale du comportement mécanique in vitro du rachis cervical [thèse]. Paris: Ensam; 1993. p. 1–234.

    Google Scholar 

  37. White AA. Clinical biomechanics of the spine. 2nd ed. Philadelphia: Lippincott; 1990.

    Google Scholar 

  38. Wolfla CE, Yoganandan N. Chapter 5: Biomechanics of the craniovertebral junction. In: Goel A, Cacciola F, editors. The craniovertebral junction: Thieme Publishers; 2011. p. 33–8.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Spine and Spinal Cord Surgery Department, Pierre Wertheimer University Hospital, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, Lyon, France

    Cédric Barrey, Mehdi Afathi, Théo Broussolle & Corentin Dauleac

  2. Orthopaedic Surgery Department, Cochin Hospital, Assistance Publique des Hôpitaux de Paris, Paris, France

    Philippe Bancel

Authors
  1. Cédric Barrey
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  2. Mehdi Afathi
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  3. Théo Broussolle
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  4. Corentin Dauleac
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  5. Philippe Bancel
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Correspondence to Cédric Barrey .

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Editors and Affiliations

  1. Neurosurgical Unit, Geneva University Hospitals, Geneva, Switzerland

    Enrico Tessitore

  2. Department of Neurosurgery, North Shore University Hospitals, Manhasset, NY, USA

    Amir R. Dehdashti

  3. Neurosurgical Unit, ASL Napoli 2 Nord, Naples, Italy

    Claudio Schonauer

  4. Department of Neurosurgery, Innsbruck University Hospitals, Innsbruck, Austria

    Claudius Thomé

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Barrey, C., Afathi, M., Broussolle, T., Dauleac, C., Bancel, P. (2020). Craniovertebral Junction Instability and Mechanisms of Injury. In: Tessitore, E., Dehdashti, A., Schonauer, C., Thomé, C. (eds) Surgery of the Cranio-Vertebral Junction. Springer, Cham. https://doi.org/10.1007/978-3-030-18700-2_19

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  • DOI: https://doi.org/10.1007/978-3-030-18700-2_19

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-18699-9

  • Online ISBN: 978-3-030-18700-2

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