Abstract
The craniocervical junction (CCJ) is comprised of the inferior surface of the skull, the atlas and axis, as well as muscles and connective tissues that attach the skull to the cervical spine. The CCJ encloses the central nervous system (CNS), encephalic vasculature and the cerebrospinal fluid (CSF) system. The CCJ spans the brainstem to the spinal cord, including the vascular system as well as connecting the cerebrospinal fluid (CSF) cisterns within the skull to the CSF channels in the spinal canal. Malformation and misalignment of the craniocervical junction can cause a constellation of cerebral and other neurological signs and symptoms collectively called craniocervical syndrome (CCS). The signs and symptoms of craniocervical junction syndrome may be due to mechanical strain causing deformation of dura mater, vasculature and other structures of the cranial vault resulting in irritation of and dysfunction of affected tissues. Deformation of the CCJ may also obstruct blood and CSF flow. Chronic ischemia, edema and hydrocephalus can cause degenerative cascades that can in turn lead to neurodegenerative diseases.
Highlights
The tectorial membrane is a continuation of the posterior longitudinal ligament and coalesces with the periosteum lining along the anterior margin of the foramen magnum at the basion [6, 12, 13]
The spinal cord subsequently can become tethered to each spinal segment by way of the dentate ligaments, and such loss of the cervical lordosis may create traction on the spinal cord resulting in a caudal downward pulling of the brain and cranial elements downward into the foramen magnum [16, 17]
FONAR upright weight bearing MRI has been shown to be most sensitive in detecting cerebellar tonsillar ectopia since weight- bearing posture presents the cerebellar tonsils further distended into the foramen magnum [18]
Summary
The cervical spine is made up of seven vertebrae divided into upper and lower sections. The upper cervical spine includes the first two vertebrae, classically named atlas (C1) and axis (C2). The CCJ links the skull to the upper cervical spine and the foramen magnum
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