The Spine Journal
Volume 10, Issue 3 , Pages 219-229 , March 2010

Comprehensive computed tomography assessment of the upper cervical anatomy: what is normal?

  • Kristen E. Radcliff, MD

      Affiliations

    • Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th Floor, Houston, TX 77030, USA
    • ,
  • Peleg Ben-Galim, MD

      Affiliations

    • Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th Floor, Houston, TX 77030, USA
    • ,
  • Niv Dreiangel, MD

      Affiliations

    • Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th Floor, Houston, TX 77030, USA
    • ,
  • Shannon B. Martin, BA

      Affiliations

    • Department of Chemistry, University of Houston, Houston, TX, USA
    • ,
  • Charles A. Reitman, MD

      Affiliations

    • Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th Floor, Houston, TX 77030, USA
    • ,
  • James N. Lin, MD

      Affiliations

    • Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th Floor, Houston, TX 77030, USA
    • ,
  • John A. Hipp, PhD

      Affiliations

    • Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th Floor, Houston, TX 77030, USA
    • Spine Research Laboratory Lab, Research Service Line, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX, USA
    • Corresponding Author InformationCorresponding author. Department of Orthopedic Surgery, Baylor College of Medicine, 6620 Main St., 11th floor, Houston, TX 77030, USA. Tel.: (832) 651-7083; fax: (713) 986-7411.

Received 8 July 2009 ,Revised 27 November 2009 ,Accepted 25 December 2009.

References 

  1. Adams VI. Neck injuries: I. Occipitoatlantal dislocation—a pathologic study of twelve traffic fatalities. J Forensic Sci. 1992;37:556–564
  2. Ahuja A, Glasauer FE, Alker GJ, Klein DM. Radiology in survivors of traumatic atlanto-occipital dislocation. Surg Neurol. 1994;41:112–118
  3. Alker GJ, Oh YS, Leslie EV. High cervical spine and craniocervical junction injuries in fatal traffic accidents: a radiological study. Orthop Clin North Am. 1978;9:1003–1010
  4. Bucholz RW, Burkhead WZ. The pathological anatomy of fatal atlanto-occipital dislocations. J Bone Joint Surg Am. 1979;61:248–250
  5. Dvorak J, Schneider E, Saldinger P, Rahn B. Biomechanics of the craniocervical region: the alar and transverse ligaments. J Orthop Res. 1988;6:452–461
  6. Harris MB, Duval MJ, Davis JA, Bernini PM. Anatomical and roentgenographic features of atlantooccipital instability. J Spinal Disord. 1993;6:5–10
  7. Jackson RS, Banit DM, Rhyne AL, Darden BV. Upper cervical spine injuries. J Am Acad Orthop Surg. 2002;10:271–280
  8. Ben-Galim PJ, Sibai TA, Hipp JA, et al. Internal decapitation: survival after head to neck dissociation injuries. Spine. 2008;33:1744–1749
  9. Kleweno CP, Zampini JM, White AP, et al. Survival after concurrent traumatic dislocation of the atlanto-occipital and atlanto-axial joints: a case report and review of the literature. Spine. 2008;33:E659–E662
  10. Yüksel KZ, Yüksel M, Gonzalez LF, et al. Occipitocervical vertical distraction injuries: anatomical biomechanical, and 3-tesla magnetic resonance imaging investigation. Spine. 2008;33:2066–2073
  11. Pfirrmann CWA, Binkert CA, Zanetti M, et al. MR morphology of alar ligaments and occipitoatlantoaxial joints: study in 50 asymptomatic subjects. Radiology. 2001;218:133–137
  12. Bellabarba C, Mirza SK, West GA, et al. Diagnosis and treatment of craniocervical dislocation in a series of 17 consecutive survivors during an 8-year period. J Neurosurg Spine. 2006;4:429–440
  13. Labler L, Eid K, Platz A, et al. Atlanto-occipital dislocation: four case reports of survival in adults and review of the literature. Eur Spine J. 2004;13:172–180
  14. Chaljub G, Singh H, Gunito FC, Crow WN. Traumatic atlanto-occipital dislocation: MRI and CT. Neuroradiology. 2001;43:41–44
  15. Harris JH. Malalignment: signs and significance. Eur J Radiol. 2002;42:92–99
  16. Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation—Part 2: the clinical use of (occipital) condyle-C1 interval, comparison with other diagnostic methods, and the manifestation, management, and outcome of atlanto-occipital dislocation in children. Neurosurgery. 2007;61:995–1015
  17. Pang D, Nemzek WR, Zovickian J. Atlanto-occipital dislocation: Part 1—Normal occipital condyle-C1 interval in 89 children. Neurosurgery. 2007;61:514–521
  18. Bono CM, Vaccaro AR, Fehlings M, et al. Measurement techniques for upper cervical spine injuries: consensus statement of the Spine Trauma Study Group. Spine. 2007;32:593–600
  19. Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am. 1989;71:15–22
  20. Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation. Case report. J Neurosurg. 1986;65:863–870
  21. Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA. Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg. 2000;93(1 Suppl):28–39
  22. Barrett TW, Mower WR, Zucker MI, Hoffman JR. Injuries missed by limited computed tomographic imaging of patients with cervical spine injuries. Ann Emerg Med. 2006;47:129–133
  23. McCulloch PT, France J, Jones DL, et al. Helical computed tomography alone compared with plain radiographs with adjunct computed tomography to evaluate the cervical spine after high-energy trauma. J Bone Joint Surg Am. 2005;87:2388–2394
  24. Dziurzynski K, Anderson PA, Bean DB, et al. A blinded assessment of radiographic criteria for atlanto-occipital dislocation. Spine. 2005;30:1427–1432
  25. Kaufman RA, Carroll CD, Buncher CR. Atlantooccipital junction: standards for measurement in normal children. AJNR Am J Neuroradiol. 1987;8:995–999
  26. Kaufman RA, Dunbar JS, Botsford JA, McLaurin RL. Traumatic longitudinal atlanto-occipital distraction injuries in children. AJNR Am J Neuroradiol. 1982;3:415–419
  27. Rojas CA, Bertozzi JC, Martinez CR, Whitlow J. Reassessment of the craniocervical junction: normal values on CT. AJNR Am J Neuroradiol. 2007;28:1819–1823
  28. Chang W, Alexander MT, Mirvis SE. Diagnostic determinants of craniocervical distraction injury in adults. AJR Am J Roentgenol. 2009;192:52–58
  29. Rosset A, Spadola L, Ratib O. OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging. 2004;17:205–216
  30. Ishii T, Mukai Y, Hosono N, et al. Kinematics of the upper cervical spine in rotation: in vivo three-dimensional analysis. Spine. 2004;29:E139–E144
  31. Harris JH, Carson GC, Wagner LK, Kerr N. Radiologic diagnosis of traumatic occipitovertebral dissociation: 2. Comparison of three methods of detecting occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994;162:887–892
  32. Doherty BJ, Heggeness MH. Quantitative anatomy of the second cervical vertebra. Spine. 1995;20:513–517
  33. Doherty BJ, Heggeness MH. The quantitative anatomy of the atlas. Spine. 1994;19:2497–2500

 FDA device/drug status: not applicable.

 Author disclosures: JAH (stock ownership, including options and warrants, Medical Metrics, Inc., other office, Medical Metrics, Inc.; grants, DARPA).

 A research fellowship grant from Medtronic provided salary support for the research fellow (ND) and is gratefully acknowledged.

PII: S1529-9430(10)00005-7

doi: 10.1016/j.spinee.2009.12.021

The Spine Journal
Volume 10, Issue 3 , Pages 219-229 , March 2010

Article Tools

* Image Usage & Resolution