Vertical atlantoaxial distraction injuries: radiological criteria and clinical implications

L. Fernando GonzalezDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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David FiorellaDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Neil R. CrawfordDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Robert C. WallaceDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Iman Feiz-ErfanDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Denise DrummDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Stephen M. PapadopoulosDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Volker K.H. SonntagDivisions of Neurological Surgery and Neuroradiology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix; and Scottsdale Healthcare, Scottsdale, Arizona

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Object. The authors sought to establish radiological criteria for the diagnosis of C1–2 vertical distraction injuries.

Methods. Conventional radiography, computerized tomography (CT), and magnetic resonance (MR) imaging findings in five patients with a C1–2 vertical distraction injury were correlated with their clinical history, operative findings, and autopsy findings. The basion—dens interval (BDI) and the C-1 and C-2 lateral mass interval (LMI) were measured in 93 control patients who underwent CT angiography; these measurements were used to define the normal BDI and LMI. The MR imaging results obtained in 30 healthy individuals were used to characterize the normal signal intensity of the C1–2 joint. The MR imaging results were compared with MR images obtained in five patients with distraction injuries.

In the 93 patients, the BDI averaged 4.7 mm (standard deviation [SD] 1.7 mm, range 0.6–9 mm) and the LMI averaged 1.7 mm (SD 0.48 mm, range 0.7–3.3 mm). Based on CT scanning in the five patients with distraction injuries, the BDIs (mean 11.9 mm, SD 3.2 mm; p < 0.001) and LMIs (mean 5.5 mm, SD 2 mm; p < 0.0001) were significantly greater than in the control group. Fast—spin echo inversion-recovery MR images obtained in these five patients revealed markedly increased signal distributed throughout the C1–2 lateral mass articulations bilaterally.

Conclusions. In 95% of healthy individuals, the LMI ranged between 0.7 and 2.6 mm. An LMI greater than 2.6 mm indicates the possibility of a distraction injury, which can be confirmed using MR imaging. Patients with a suspected C1–2 distraction injury may be candidates for surgical fusion of C1–2.

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  • 1.

    Adams VI: Neck injuries: II. Atlantoaxial dislocation—a pathologic study of 14 traffic fatalities. J Forensic Sci 37:565573, 1992 Adams VI: Neck injuries: II. Atlantoaxial dislocation—a pathologic study of 14 traffic fatalities. J Forensic Sci 37:565–573, 1992

    • Search Google Scholar
    • Export Citation
  • 2.

    Botelho RV, , de Souza Palma AM, & Abgussen CM, et al: Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review. Eur Spine J 9:430433, 2000 Botelho RV, de Souza Palma AM, Abgussen CM, et al: Traumatic vertical atlantoaxial instability: the risk associated with skull traction. Case report and literature review. Eur Spine J 9:430–433, 2000

    • Search Google Scholar
    • Export Citation
  • 3.

    Carroll EA, , Gordon B, & Sweeney CA, et al: Traumatic atlantoaxial distraction injury: a case report. Spine 26:454457, 2001 Carroll EA, Gordon B, Sweeney CA, et al: Traumatic atlantoaxial distraction injury: a case report. Spine 26:454–457, 2001

    • Search Google Scholar
    • Export Citation
  • 4.

    Davis D, , Bohlman H, & Walker AE, et al: The pathological findings in fatal craniospinal injuries. J Neurosurg 34:603613, 1971 Davis D, Bohlman H, Walker AE, et al: The pathological findings in fatal craniospinal injuries. J Neurosurg 34:603–613, 1971

    • Search Google Scholar
    • Export Citation
  • 5.

    Dickman CA, , Mamourian A, & Sonntag VK, et al: Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 75:221227, 1991 Dickman CA, Mamourian A, Sonntag VK, et al: Magnetic resonance imaging of the transverse atlantal ligament for the evaluation of atlantoaxial instability. J Neurosurg 75:221–227, 1991

    • Search Google Scholar
    • Export Citation
  • 6.

    Dickman CA, , Papadopoulos SM, & Sonntag VK, et al: Traumatic occipitoatlantal dislocations. J Spinal Disord 6:300313, 1993 Dickman CA, Papadopoulos SM, Sonntag VK, et al: Traumatic occipitoatlantal dislocations. J Spinal Disord 6:300–313, 1993

    • Search Google Scholar
    • Export Citation
  • 7.

    Gonzalez LF, , Crawford NR, & Chamberlain RH, et al: Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique. J Neurosurg (Spine 2) 98:202209, 2003 Gonzalez LF, Crawford NR, Chamberlain RH, et al: Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique. J Neurosurg (Spine 2) 98:202–209, 2003

    • Search Google Scholar
    • Export Citation
  • 8.

    Hammer AJ: Lower cranial nerve palsies. Potentially lethal in association with upper cervical fracture-dislocations. Clin Orthop 266:6469, 1991 Hammer AJ: Lower cranial nerve palsies. Potentially lethal in association with upper cervical fracture-dislocations. Clin Orthop 266:64–69, 1991

    • Search Google Scholar
    • Export Citation
  • 9.

    Huang CI, , Chen IH, & Lee LS: Traumatic atlantoaxial distractive instability: case report. J Trauma 36:599600, 1994 Huang CI, Chen IH, Lee LS: Traumatic atlantoaxial distractive instability: case report. J Trauma 36:599–600, 1994

    • Search Google Scholar
    • Export Citation
  • 10.

    Lee C, , Rogers LF, & Woodring JH, et al: Fractures of the craniovertebral junction associated with other fractures of the spine: overlooked entity? AJNR 5:775781, 1984 Lee C, Rogers LF, Woodring JH, et al: Fractures of the craniovertebral junction associated with other fractures of the spine: overlooked entity? AJNR 5:775–781, 1984

    • Search Google Scholar
    • Export Citation
  • 11.

    Lee C, , Woodring JH, & Goldstein SJ, et al: Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 8:1926, 1987 Lee C, Woodring JH, Goldstein SJ, et al: Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 8:19–26, 1987

    • Search Google Scholar
    • Export Citation
  • 12.

    Monu J, , Bohrer SP, & Howard G: Some upper cervical spine norms. Spine 12:515519, 1987 Monu J, Bohrer SP, Howard G: Some upper cervical spine norms. Spine 12:515–519, 1987

    • Search Google Scholar
    • Export Citation
  • 13.

    Przybylski GJ, & Welch WC: Longitudinal atlantoaxial dislocation with type III odontoid fracture. Case report and review of the literature. J Neurosurg 84:666670, 1996 Przybylski GJ, Welch WC: Longitudinal atlantoaxial dislocation with type III odontoid fracture. Case report and review of the literature. J Neurosurg 84:666–670, 1996

    • Search Google Scholar
    • Export Citation
  • 14.

    Ramaré S, , Lazennec JY, & Camelot C, et al: Vertical atlantoaxial dislocation. Eur Spine J 8:241243, 1999 Ramaré S, Lazennec JY, Camelot C, et al: Vertical atlantoaxial dislocation. Eur Spine J 8:241–243, 1999

    • Search Google Scholar
    • Export Citation
  • 15.

    Silbergeld DL, , Laohaprasit V, & Grady MS, et al: Two cases of fatal atlantoaxial distraction injury without fracture or rotation. Surg Neurol 35:5456, 1991 Silbergeld DL, Laohaprasit V, Grady MS, et al: Two cases of fatal atlantoaxial distraction injury without fracture or rotation. Surg Neurol 35:54–56, 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    Traynelis VC, , Marano GD, & Dunker RO, et al: Traumatic atlantooccipital dislocation. Case report. J Neurosurg 65:863870, 1986 (Erratum. J Neurosurg 66:789, 1987) Traynelis VC, Marano GD, Dunker RO, et al: Traumatic atlantooccipital dislocation. Case report. J Neurosurg 65:863–870, 1986 (Erratum. J Neurosurg 66:789, 1987)

    • Search Google Scholar
    • Export Citation
  • 17.

    Weiner BK, & Brower RS: Traumatic vertical atlantoaxial instability in a case of atlanto-occipital coalition. Spine 22:10331035, 1997 Weiner BK, Brower RS: Traumatic vertical atlantoaxial instability in a case of atlanto-occipital coalition. Spine 22:1033–1035, 1997

    • Search Google Scholar
    • Export Citation
  • 18.

    Werne S: Studies in spontaneous atlas dislocation. Acta Orthop Scand Suppl 23:1150, 1957 Werne S: Studies in spontaneous atlas dislocation. Acta Orthop Scand Suppl 23:1–150, 1957

    • Search Google Scholar
    • Export Citation
  • 19.

    White AA III, & Panjabi MM: Clinical Biomechanics of the Spine, ed 2. Philadelphia: Lippincott Williams & Wilkins, 1990 White AA III, Panjabi MM: Clinical Biomechanics of the Spine, ed 2. Philadelphia: Lippincott Williams & Wilkins, 1990

    • Search Google Scholar
    • Export Citation
  • 20.

    Wholey MH, , Bruwer AJ, & Baker HL Jr: The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 71:350356, 1958 Wholey MH, Bruwer AJ, Baker HL Jr: The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 71:350–356, 1958

    • Search Google Scholar
    • Export Citation

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