Learning objectives
The purpose of this poster is to:
1) Review the normal appearances of the craniocervical junction and cervical spine (including those anatomical variants also considered 'normal').
2) To illustrate,
with the relevant clinical imaging,several cases of torticollis and head-tilt which have been encountered at York District Hospital.
Background
Torticollis may be congenital or aquired and is encountered in both paediatric and adult populations.
It is characterised by shortening of the sternocleidomastoid muscleanda rotational deformity of the cervical spine which produces a secondary head tilt. Acquired torticollis is often asscociated with infection or trauma and is more common in older children and adults. In infants and younger children torticollis is more likely to be muscular (e.g.
fibromatosis colli) or congenital associated withanatomical anomalies of the craniocervical junction and / or upper cervical spine.
Radiologists...
Imaging findings OR Procedure Details
NORMAL APPEARANCES:
In Fig. 1 we demonstrate the'column' concept of spinal alignment as applicable to the cervical spine.
In Fig. 2 weshow the normal relationship of the atlantoaxial junction when viewed in the sagittal plane. In Fig. 3 the normal predental space (as measured from the posterior cortex of the anterior arch of C1 to the anterior cortex of the odontoid process of C2). The normal apparances of the C1 and C2 ossification centres are illustrated in Fig. 4. C1 is formed from three primary...
Conclusion
1) Abnormalities of the craniocervical junction and cervical spine can be complex. Radiologists play a crucial role in diagnosisng such abnormalities and regardless of speciality should be able to facillitiate appropriate imaging in an expeditious manner.
2) Radiologists need to have a sound understanding of the normal appearances of the craniocervical junction and spine,
including the 'normal anatomical variants'.
3) Distinguishing clinically urgent and important causes from more indolent and benign causesis important in ensuring patients are managed appropriately.
References
Haque,
S.,
Shafi,
B.B.B.,
Kaleem,
M.; Imaging of Torticollis in Children; Radiographics; March 2012; Volume 32; Number 2; Pages 557-571
Lustrin,
E.
et al; Paediatric Cervical Spine: Normal anatomy,
variants and trauma; Radiographics; Volume 23,
number 3; May 2003.
Snyder,
E.M.,
Coley,
B.D.,; Limited value of Plain radiographs in infant torticollis; Paediatrics; Volume 118,
Number 6; December 2006.
Karwacki,
G.M.
and Schneider,
J.F.; Normal ossification patterns of Atlas and Axis A CT study; American Journal of Neuroradiology; May 2012.
Perez,
M.M.
et al; Torticollis in...
Personal Information
Dr Robert Turney - Radiology registrar,
York District Hospital,
York,
UK.
[email protected]
Dr Neil Jenkins - Consultant Radiologist,
York District Hospital,
York,
UK.
Dr Kate Kingston - Consultant Radiologist,
York District Hospital,
York,
UK.
[email protected]