Cranio cervical junction -dr. k.shanmuganathan

Cranio cervical junction -dr. k.shanmuganathan

1. Imaging of the Cervical Spine:
Cranio-cervical Junction
3
rd
National Conference SER 2016
Bengaluru, India 23-25 September 2016
K.SHANMUGANATHAN. M.D.

2. Imaging of the Cervical Spine:
Craniocervical Junction
Objectives
•Axis Fx’s -Dens fracture, Hangman’s
fracture
•Atlanto-occipital dissociation (AOD)
•Normal anatomy

3. DENS FRACTURE

4. DENS FRACTURE
•Commonest Fx > 65 Yrs
•Mechanism – MVC & fall
•Three types
•Type II - nonunion

5. DENS FRACTURE
•Subtle on lateral radiographs & axial CT

•Step off or disruption – cortex or C2 ring

6. Anderso &
D’Alonzo in:
The
Radiology of
Acute
Cervical
Spine
Trauma
Harris JH ,
Mirvis SE

8. Courtesy of Mann FA

16. TRAUMATIC
SPONDYLOLISTHESIS

17. TRAUMATIC
SPONDYLOLISTHESIS
•Hyperextension & axial loading
•Pars interarticularis
•MVC

18. Effendi et al
The Radiology of
Acute Cervical
Spine Trauma
Harris JH ,
Mirvis SE

24. C2-3
C2-3

26. ATLANTO-OCCIPITAL
DISSOCIATION

27. ATLANTO-OCCIPITAL
DISSOCIATION
•Uncommon injury
•Three types – direction the skull displaces
Anterior, Posterior, Vertical
•Subtle – radiographs, CT, MRI

29. ATLANTO-OCCIPITAL
DISSOCIATION
•X- line method
•Powers ratio
•Basion-dental interval (BDI)
Basion-axial interval (BAI)
> 12 mm

30. 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
+

31. >12mm

33. B
O

34. 7 mm

35. ADC
E1 E 2&E3