Learning objectives
Our aim is to interpret the imaging findings of the craniocervical junction in magnetic resonance imaging (MRI) and computed tomography (CT), in relation to the possible involvement of this region in various musculoskeletal disorders.
Background
The craniocervical junction is a joint made of the occiput, atlas, odontoid process and ligamentous support structures. It has contact with nerve structures, including the medulla oblongata, spinal cord and lower cranial nerves. MRI is the reference imaging technique to assess pathological findings at this level, allowing an excellent morphological definition of structures, particularly soft tissue. CT allows a better visualization of bone alterations and is useful for craniometric measurements.
The craniocervical junction may be involved in several musculoskeletal disorders. Early diagnosis is essential to...
Findings and procedure details
RA frequently affects the upper cervical structures (C1 and C2, with atlantoaxial, atlantoodontoid and atlantooccipital joints). In RA the inflammatory process is characterized by the presence of synovial proliferation with subsequent bone erosions (Fig.1,2,3) and weakening/rupture of the supporting ligaments. These events may lead to instability with possible atlantoaxial subluxation, compression of the cervicomedullary junction and subaxial subluxation.
Anterior atlantoaxial subluxation (AAS) ismore common than posterior and lateral AAS. Anterior AAS can be diagnosed when the anterior atlantoodontoid interval, i.e. the space between the posterior...
Conclusion
In patients with musculoskeletal diseases and cervical symptoms, the involvement of the craniocervical junction should be suspected.
MRI is the reference modality to assess soft tissues and to evaluate compression marks on neural structures.
Early detection of cervical spine involvement is essential for effective treatment and to avoid potentially life-threatening complications.
Personal information and conflict of interest
G. Facchini; Bologna/IT - nothing to disclose L. Ceccarelli; Bologna/IT - nothing to disclose F. Ponti; Bologna/IT - nothing to disclose P. Spinnato; Bologna/IT - nothing to disclose R. Clinca; Bologna/IT - nothing to disclose L. Lotrecchiano; Bologna/IT - nothing to disclose
References
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