Role of imaging in craniovertebral junction abnormalities

Abstract

Background: Craniovertebral junction (CVJ) abnormalities constitute an important group of treatable neurological disorders with diagnostic dilemma. Their precise diagnosis and pre-treatment evaluation significantly affects prognosis and quality of life of patients. Aims: To localize, describe and characterize craniovertebral junction abnormalities, arrange frequently detected CVJ pathologic imaging findings and to emphasize clinical implications to improve our radiological report. Materials and methods: A Cross sectional study done for 24 months in 50 patients of all age groups with clinical suspicion of CVJ abnormalities.Results: In the acquired CVJ abnormality Trauma is the most common etiology(n=15) followed by Tuberculosis(n=4), Rheumatoid arthritis(n=3), Tumors(n=2). Most common age group involved was 2nd decade with male predominance. Most commonly presenting symptom is weakness of limbs followed by neck pain. Most common imaging abnormality is cervicomedullary junction compression and atlanto axial dislocation. ACM I and Syringomyelia are the commonest neural anomalies associated with bony CVJ anomalies. Most common congenital anomalies are atlanto axial dislocation followed by basilar invagination. Only one patient had syndromic association which was Klippel-feil syndrome. The commonest injuries involving the CVJ were odontoid fracture predominantly type II and the commonest combination of injury was C1 with odontoid fracture.