Type:
Educational Exhibit
Keywords:
Neuroradiology spine, Bones, CT, MR, Conventional radiography, Diagnostic procedure, Congenital
Authors:
M. Boumediene1, A. DAGHFOUS2, E. JEMEL3, M. Boukoucha3; 1Tunis/TN, 2BEN AROUS/TN, 3Tunis /TN
DOI:
10.26044/ecr2019/C-3192
Background
Bone malformations of the cervico-occipital junction (MCOJ) are constitutional abnormalities of the cranio-rachidian junction grouping,
on the one hand,
the major bone malformations and on the other hand minor malformations.
They are secondary to embryological disorders,
some of which fall within the framework of chromosomal abnormalities or observed in the context of genetic syndromes.
They are diverse and often associated with each other.
It is a benign,
congenital,
disabling,
slowly progressive and sometimes brutal decompensation.
Its clinical and radiological expression is very polymorphic,
explained by the anatomical richness of this region.
The first description of the MCOJ was in 1880 by BELL who reported the first case of atlanto-axoidal dislocation.
It was not until 1939 that Chamberlain published his radiological studies on basilar impression,
inspired by various autopsy studies [1].
In 1948,
Mc Gregor reviewed the development history of measurements for the diagnosis of basilar footprint on standard radiographs [2].
The radiological exploration of patients with MCOJ,
previously limited to standard radiographs,
although offering a study both static and dynamic cervico-occipital junction (COJ),
it did not allow a fine analysis of bone structures and especially neuropathy from which it is impossible to evaluate the impact of osteo-ligamentous lesions on the spinal cord.
The advent of modern imaging has completely changed the diagnostic approach of MCOJ by occupying a prominent place in pre- and post-operative care.
Computed tomography (CT) with multiplanar and 3D (3-dimensional) studies allows precise analysis of bone abnormalities,
especially minor,
not diagnosed by standard radiographs.
However,
it offers a meticulous study of bone structures without analysis of the spinal cord injury.
Magnetic resonance imaging (MRI) offers the comfort of simultaneously viewing the container and the contents and this in the different planes of space thus showing the impact of MCOJ on the bulbo-medullary junction and the associated nervous malformations,
but remains limited in the fine analysis of bone structures.