open access
Morphometric multislice computed tomography examination of the craniovertebral junction in neck flexion and extension
open access
Abstract
Background: Detailed study of the craniovertebral junction (CVJ) is necessary to completely understand the mechanism of its flexion and extension.
Materials and methods: One cadaver head was sectioned in the sagittal plane. Also, in 22 volunteers, examined using the multislice computed tomography (MSCT), 14 parameters and 2 angles were measured in the neutral position, flexion and extension.
Results: The obtained measurements showed the anterior part of the occiput to move inferiorly in flexion, and the anterior atlas arch and the tip of the dens to get closer to the basion. At the same time, the opisthion moves superiorly, but the cervical spine bends anteriorly. Consequently, the dens-opisthion diameter and the opisthion-posterior atlas arch distance slightly decrease in length, whilst the arches of the atlas (C1), axis (C2) and C3 vertebra become more distant. Following extension, the posterior part of the occiput moves inferiorly, so that the basion-dens tip, the basion-axis arch, and the basion-posterior atlas arch distances increase in length. In contrast, the distances of the C1–C3 arches decrease in length. The angle between the foramen magnum and the dens tip decreases 1.620 on average in flexion, but increases 3.230 on average in extension. The angle between the axis body and the opisthion also decreases in flexion (mean, 3.360) and increases in extension (mean, 6.570). Among the congenital anomalies, a partial agenesis of the posterior atlas arch was revealed (4.5%), as well as an anterior dehiscence of the C1 foramen transversarium (13.6%).
Conclusions: The mentioned measurements improved our understanding of the CVJ biomechanics. The obtained data can be useful in the evaluation of the CVJ instability caused by trauma, congenital anomalies and certain spine diseases.
Abstract
Background: Detailed study of the craniovertebral junction (CVJ) is necessary to completely understand the mechanism of its flexion and extension.
Materials and methods: One cadaver head was sectioned in the sagittal plane. Also, in 22 volunteers, examined using the multislice computed tomography (MSCT), 14 parameters and 2 angles were measured in the neutral position, flexion and extension.
Results: The obtained measurements showed the anterior part of the occiput to move inferiorly in flexion, and the anterior atlas arch and the tip of the dens to get closer to the basion. At the same time, the opisthion moves superiorly, but the cervical spine bends anteriorly. Consequently, the dens-opisthion diameter and the opisthion-posterior atlas arch distance slightly decrease in length, whilst the arches of the atlas (C1), axis (C2) and C3 vertebra become more distant. Following extension, the posterior part of the occiput moves inferiorly, so that the basion-dens tip, the basion-axis arch, and the basion-posterior atlas arch distances increase in length. In contrast, the distances of the C1–C3 arches decrease in length. The angle between the foramen magnum and the dens tip decreases 1.620 on average in flexion, but increases 3.230 on average in extension. The angle between the axis body and the opisthion also decreases in flexion (mean, 3.360) and increases in extension (mean, 6.570). Among the congenital anomalies, a partial agenesis of the posterior atlas arch was revealed (4.5%), as well as an anterior dehiscence of the C1 foramen transversarium (13.6%).
Conclusions: The mentioned measurements improved our understanding of the CVJ biomechanics. The obtained data can be useful in the evaluation of the CVJ instability caused by trauma, congenital anomalies and certain spine diseases.
Keywords
atlas, axis, craniovertebral junction, extension, flexion, multislice computed tomography, occipital condyle
About this articleTitle
Morphometric multislice computed tomography examination of the craniovertebral junction in neck flexion and extension
Journal
Issue
Article type
Original article
Pages
100-109
Published online
2016-07-04
Page views
1470
Article views/downloads
1177
DOI
Pubmed
Bibliographic record
Folia Morphol 2017;76(1):100-109.
Keywords
atlas
axis
craniovertebral junction
extension
flexion
multislice computed tomography
occipital condyle
Authors
S. Marinković
I. Milić
I. Djorić
L. Brigante
A. Miljatović
L. Puškaš
S. Kapor
J. Boljanović
References (37)- Billmann F, Le Minor JM. Transverse foramen of the atlas (C1) anteriorly unclosed: a misknown human variant and its evolutionary significance. Spine. 2009; 34(12): E422–E426.
- Bilston LE, Thibault LE. The mechanical properties of the human cervical spinal cord in vitro. Ann Biomed Eng. 1996; 24(1): 67–74.
- Caro AF, Prieto PM, Berciano F. Congenital defect of the atlas and axis. A cause of misdiagnose when evaluating an acute neck trauma. Am J Emerg Med. 2008; 26: e1–840.e2.
- Chau AM, Wong JHY, Mobbs RJ. Cervical myelopathy associated with congenital C2/3 canal stenosis and deficiencies of the posterior arch of the atlas and laminae of the axis: case report and review of the literature. Spine. 2009; 34(24): E886–E891.
- Currarino G, Rollins N, Diehl JT. Congenital defects of the posterior arch of the atlas: a report of seven cases including an affected mother and son. AJNR Am J Neuroradiol. 1994; 15(2): 249–254.
- D'Andrea K, Dreyer J, Fahim DK. Utility of Preoperative Magnetic Resonance Imaging Coregistered with Intraoperative Computed Tomographic Scan for the Resection of Complex Tumors of the Spine. World Neurosurg. 2015; 84(6): 1804–1815.
- Elmalky MM, Elsayed S, Arealis G, et al. Congenital C1 arch deficiency: Grand Round presentation. Eur Spine J. 2013; 22(6): 1223–1226.
- Endo K, Suzuki H, Nishimura H, et al. Kinematic analysis of the cervical cord and cervical canal by dynamic neck motion. Asian Spine J. 2014; 8(6): 747–752.
- Fiford RJ, Bilston LE. The mechanical properties of rat spinal cord in vitro. J Biomech. 2005; 38(7): 1509–1515.
- Garant M, Oudjhane K, Sinsky A, et al. Duplicated odontoid process: plain radiographic and CT appearance of a rare congenital anomaly of the cervical spine. AJNR Am J Neuroradiol. 1997; 18(9): 1719–1720.
- Garrett M, Consiglieri G, Kakarla UK, et al. Occipitoatlantal dislocation. Neurosurgery. 2010; 66(3 Suppl): 48–55.
- Gerigk L, Bostel T, Hegewald A, et al. Dynamic magnetic resonance imaging of the cervical spine with high-resolution 3-dimensional T2-imaging. Clin Neuroradiol. 2012; 22(1): 93–99.
- Gomez MA, Damie F, Besson M, et al. [Congenital absence of a cervical spine pedicle: misdiagnosis in a context of trauma]. Rev Chir Orthop Reparatrice Appar Mot. 2003; 89(8): 738–741.
- Hu Y, Ma W, Xu R. Transoral osteosynthesis C1 as a function-preserving option in the treatment of bipartite atlas deformity: a case report. Spine. 2009; 34(11): E418–E421.
- Kakarla UK, Chang SW, Theodore N, et al. Atlas fractures. Neurosurgery. 2010; 66(3 Suppl): 60–67.
- Klimo P, Blumenthal DT, Couldwell WT. Congenital partial aplasia of the posterior arch of the atlas causing myelopathy: case report and review of the literature. Spine. 2003; 28(12): E224–E228.
- Lao Lf, Zhong Gb, Li Qy, et al. Kinetic magnetic resonance imaging analysis of spinal degeneration: a systematic review. Orthop Surg. 2014; 6(4): 294–299.
- Le Minor JM, Koritke JG. [Associations among non-metric features of the atlas in the human species]. Arch Anat Histol Embryol. 1991; 74: 11–26.
- Lopez AJ, Scheer JK, Leibl KE, et al. Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus. 2015; 38(4): E2.
- Lord EL, Alobaidan R, Takahashi S, et al. Kinetic magnetic resonance imaging of the cervical spine: a review of the literature. Global Spine J. 2014; 4(2): 121–128.
- Magu S, Singh D, Yadav RK, et al. Evaluation of Traumatic Spine by Magnetic Resonance Imaging and Correlation with Neurological Recovery. Asian Spine J. 2015; 9(5): 748–756.
- Martin MD, Bruner HJ, Maiman DJ. Anatomic and biomechanical considerations of the craniovertebral junction. Neurosurgery. 2010; 66(3 Suppl): 2–6.
- Milić I, Samardžić M, Djorić I, et al. Craniovertebral anomalies associated with pituitary gland duplication. Folia Morphol. 2015; 74(4): 524–531.
- Morishita Y, Falakassa J, Naito M, et al. The kinematic relationships of the upper cervical spine. Spine. 2009; 34(24): 2642–2645.
- Morishita Y, Hymanson H, Miyazaki M, et al. Review article: Kinematic evaluation of the spine: A kinetic magnetic resonance imaging study. J Orthopaedic Surg. 2008; 16(3): 348–350.
- O'Rahilly R, Müller F, Meyer DB. The human vertebral column at the end of the embryonic period proper. 2. The occipitocervical region. J Anat. 1983; 136(Pt 1): 181–195.
- Pang D, Thompson DNP. Embryology and bony malformations of the craniovertebral junction. Childs Nerv Syst. 2011; 27(4): 523–564.
- Pasku D, Katonis P, Karantanas A, et al. Congenital posterior atlas defect associated with anterior rachischisis and early cervical degenerative disc disease: a case study and review of the literature. Acta Orthop Belg. 2007; 73(2): 282–285.
- Pfirrmann CW, Binkert CA, Zanetti M, et al. Functional MR imaging of the craniocervical junction. Correlation with alar ligaments and occipito-atlantoaxial joint morphology: a study in 50 asymptomatic subjects. Schweiz Med Wochenschr. 2000; 130(18): 645–651.
- Sabuncuoglu H, Ozdogan S, Karadag D, et al. Congenital hypoplasia of the posterior arch of the atlas: case report and extensive review of the literature. Turk Neurosurg. 2011; 21(1): 97–103.
- Schlamann M, Reischke L, Klassen D, et al. Dynamic magnetic resonance imaging of the cervical spine using the NeuroSwing System. Spine. 2007; 32(21): 2398–2401.
- Shen W, Cui J, Chen J, et al. Partial midfacial duplication. J Craniofac Surg. 2013; 24(3): 934–936.
- Smoker WR. Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. Radiographics. 1994; 14(2): 255–277.
- Steinmetz MP, Mroz TE, Benzel EC. Craniovertebral junction: biomechanical considerations. Neurosurgery. 2010; 66(3 Suppl): 7–12.
- Vasudeva N, Kumar R. Absence of foramen transversarium in the human atlas vertebra: a case report. Acta Anat (Basel). 1995; 152(3): 230–233.
- Wiener MD, Martinez S, Forsberg DA. Congenital absence of a cervical spine pedicle: clinical and radiologic findings. AJR Am J Roentgenol. 1990; 155(5): 1037–1041.
- Zhang H, Bai J. Development and validation of a finite element model of the occipito-atlantoaxial complex under physiologic loads. Spine. 2007; 32(9): 968–974.
