imaging of the cervical spine: craniocervical junction · imaging of the cervical spine:...
TRANSCRIPT
![Page 1: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/1.jpg)
Imaging of the Cervical Spine: Craniocervical Junction
Eastern Radiological Society
Charleston, SC 2014
• K.SHANMUGANATHAN. M.D.
![Page 2: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/2.jpg)
Imaging of the Cervical Spine: Craniocervical Junction
Objectives
•Axis Fx’s -Dens fracture, Hangman’s fracture
•Atlanto-occipital dissociation (AOD)
•Normal anatomy
![Page 3: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/3.jpg)
DENS FRACTURE
![Page 4: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/4.jpg)
DENS FRACTURE
• Commonest Fx > 65 Yrs
• Mechanism – MVC & fall
• Three types
• Type II - nonunion
![Page 5: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/5.jpg)
DENS FRACTURE
• Subtle on lateral radiographs & axial CT
• Step off or disruption – cortex or C2 ring
![Page 6: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/6.jpg)
Anderso & D’Alonzo in: The Radiology of Acute Cervical Spine Trauma Harris JH , Mirvis SE
![Page 7: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/7.jpg)
![Page 8: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/8.jpg)
Courtesy of Mann FA
![Page 9: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/9.jpg)
![Page 10: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/10.jpg)
![Page 11: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/11.jpg)
![Page 12: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/12.jpg)
![Page 13: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/13.jpg)
![Page 14: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/14.jpg)
![Page 15: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/15.jpg)
![Page 16: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/16.jpg)
![Page 17: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/17.jpg)
TRAUMATIC SPONDYLOLISTHESIS
![Page 18: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/18.jpg)
TRAUMATIC SPONDYLOLISTHESIS
• Hyperextension & axial loading
• Pars interarticularis
• MVC
![Page 19: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/19.jpg)
Effendi et al The Radiology of Acute Cervical Spine Trauma Harris JH , Mirvis SE
![Page 20: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/20.jpg)
![Page 21: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/21.jpg)
![Page 22: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/22.jpg)
![Page 23: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/23.jpg)
![Page 24: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/24.jpg)
![Page 25: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/25.jpg)
C2-3 C2-3
![Page 26: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/26.jpg)
![Page 27: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/27.jpg)
ATLANTO-OCCIPITAL DISSOCIATION
![Page 28: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/28.jpg)
ATLANTO-OCCIPITAL DISSOCIATION
• Uncommon injury
• Three types – direction the skull displaces
Anterior, Posterior, Vertical
• Subtle – radiographs, CT, MRI
![Page 29: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/29.jpg)
![Page 30: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/30.jpg)
ATLANTO-OCCIPITAL DISSOCIATION
• X- line method
• Powers ratio
• Basion-dental interval (BDI)
Basion-axial interval (BAI)
> 12 mm
![Page 31: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/31.jpg)
ATLANTO-OCCIPITAL DISSOCIATION
Measurement Radiograph MDCT
BDI 12 mm 9.5 mm
BAI/PAL 12 mm 5.4 mm
Condylar sum - 6.2 mm
R L
+
![Page 32: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/32.jpg)
>12mm
![Page 33: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/33.jpg)
![Page 34: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/34.jpg)
BO
![Page 35: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/35.jpg)
7 mm
![Page 36: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/36.jpg)
ADC E1 E 2&E3
![Page 37: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/37.jpg)
![Page 38: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/38.jpg)
ATLANTO-OCCIPITAL DISSOCIATION
• X- line method
• Powers ratio
• Basion-dental interval (BDI)
Basion-axial interval (BAI)
> 12 mm
![Page 39: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/39.jpg)
![Page 40: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/40.jpg)
![Page 41: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/41.jpg)
![Page 42: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/42.jpg)
![Page 43: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/43.jpg)
ATLANTO-OCCIPITAL DISSOCIATION
• X- line method
• Powers ratio
• Basion-dental interval (BDI)
Basion-axial interval (BAI)
OAB
CBC / OA < 1
![Page 44: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/44.jpg)
![Page 45: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/45.jpg)
![Page 46: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/46.jpg)
![Page 47: Imaging of the Cervical Spine: Craniocervical Junction · Imaging of the Cervical Spine: Craniocervical Junction Eastern Radiological Society Charleston, SC 2014 • K.SHANMUGANATHAN](https://reader033.vdocuments.mx/reader033/viewer/2022060316/5f0c0d3d7e708231d4338234/html5/thumbnails/47.jpg)