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Clinical Orthopaedics and Related Research®

, Volume 470, Issue 6, pp 1602–1613 | Cite as

CT and MRI-based Diagnosis of Craniocervical Dislocations: The Role of the Occipitoatlantal Ligament

  • Kristen RadcliffEmail author
  • Christopher Kepler
  • Charles Reitman
  • James Harrop
  • Alexander Vaccaro
Symposium: Complications of Spine Surgery

Abstract

Background

Craniocervical dislocations are rare, potentially devastating injuries. A diagnosis of craniocervical dislocations may be delayed as a result of their low incidence and paucity of diagnostic criteria based on CT and MRI. Delay in diagnosis may contribute to neurological injury from secondary displacement resulting from instability. The purpose of this study was to define CT and MRI-based diagnostic criteria for craniocervical dislocations to facilitate early injury recognition and stabilization.

Questions/purposes

Using CT and MRI, we (1) described the bony articular displacements characterize craniocervical injuries; (2) described the ligamentous injuries that characterize craniocervical injuries; and (3) determined whether neurologic injuries were associated with bony or ligamentous injury.

Methods

Using a prospectively collected spinal cord injury database, we identified 18 patients with acute, traumatic occipitocervical injuries. We reviewed CT scans and MR images to document the height of the occipitoatlantal and atlantoaxial joints and integrity of craniocervical ligaments. Medical records were reviewed for neurological status. The primary measurements were number of patients with articular displacement, location of bony displacement, and number of patients with ligamentous injury.

Results

Thirteen of 18 patients had displacement outside the normal range. Six patients demonstrated displacement of both occipitoatlantal and atlantoaxial joints, whereas five patients presented with displacement through the atlantoaxial joints only. Two patients had an abnormal basion-dental interval only. Of 17 patients with MR images, the cruciate ligament was injured in 11 patients, indeterminate in four, and intact in two. All five patients with occipitoatlantal articular displacement had injury to the occipitoatlantal capsule. No patient had occipitoatlantal capsular injury without occipitoatlantal articular displacement. Three cases of complete spinal cord injury were found after occipitoatlantal-atlantoaxial dislocations. Three patients with occipitoatlantal-atlantoaxial dislocations were neurologically intact. The five patients with atlantoaxial dislocations and patients without displacement or ligamentous injury were neurologically intact. Five patients had cruciate ligament rupture or indeterminate injury but no joint diastasis.

Conclusions

The occipitoatlantal joint capsules stabilize the occipitoatlantal joint; disruption of the occipitoatlantal capsule may suggest the presence of instability. Based on these findings, we identified two distinct injury patterns: isolated atlantoaxial injuries (Type I) and combined occipitoatlantal-atlantoaxial injuries (Type II). Occipitoatlantal joint capsule integrity differentiated these subsets and Type II injuries had a higher percentage of complete spinal cord injuries on presentation.

Keywords

Cruciate Ligament Ligamentous Injury Occipital Condyle American Spinal Injury Association Craniocervical Junction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© The Association of Bone and Joint Surgeons® 2011

Authors and Affiliations

  • Kristen Radcliff
    • 1
    • 4
    Email author
  • Christopher Kepler
    • 1
  • Charles Reitman
    • 2
  • James Harrop
    • 3
  • Alexander Vaccaro
    • 1
  1. 1.Rothman InstituteThomas Jefferson UniversityPhiladelphiaUSA
  2. 2.Department of Orthopedic SurgeryBaylor College of MedicineHoustonUSA
  3. 3.Department of NeurosurgeryThomas Jefferson UniversityPhiladelphiaUSA
  4. 4.Egg Harbor TownshipUSA

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