title: Imaging of Atlanto-Occipital and Atlantoaxial Traumatic Injuries: What the Radiologist Needs to Know.
abstract: Approximately one-third of all cervical spine injuries involve the craniocervical junction (CCJ). Composed of the occiput and the first two cervical vertebrae, this important anatomic landmark, in conjunction with an intricate ligamentous complex, is essential to maintaining the stability of the cervical spine. The atlantoaxial joint is the most mobile portion of the spine, predominantly relying on the ligamentous framework for stability at that level. As acute onsite management of trauma patients continues to improve, CCJ injuries, which often lead to death onsite where the injury occurred, are increasingly being encountered in the emergency department. Understanding the anatomy of the CCJ is crucial in properly evaluating the cervical spine, allowing the radiologist to assess its stability in the trauma setting. The imaging findings of important CCJ injuries, such as atlanto-occipital dissociation, occipital condyle fractures, atlas fractures with transverse ligament rupture, atlantoaxial distraction, and traumatic rotatory subluxation, are important to recognize in the acute setting, often dictating patient management. Thin-section multidetector computed tomography with sagittal and coronal reformats is the study of choice in evaluating the extent of injury, allowing the radiologist to thoroughly evaluate the stability of the cervical spine. Furthermore, magnetic resonance (MR) imaging is increasingly being used to evaluate the spinal soft tissues and ligaments, and to identify associated spinal cord injury, if present. MR imaging is also indicated in patients whose neurologic status cannot be evaluated within 48 hours of injury. .
authors.affiliation: From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.).
authors.forename: Roy
authors.initials: R
authors.lastname: Riascos
authors.affiliation: From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.).
authors.forename: Eliana
authors.initials: E
authors.lastname: Bonfante
authors.affiliation: From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.).
authors.forename: Claudia
authors.initials: C
authors.lastname: Cotes
authors.affiliation: From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.).
authors.forename: Mary
authors.initials: M
authors.lastname: Guirguis
authors.affiliation: From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.).
authors.forename: Reza
authors.initials: R
authors.lastname: Hakimelahi
authors.affiliation: From the Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, 6431 Fannin St, MSB 2.130B, Houston, TX 77030 (R.R., E.B., M.G., C.W.); and Department of Radiology, University of Texas Medical Branch, Galveston, Tex (C.C., R.H.).
authors.forename: Clark
authors.initials: C
authors.lastname: West
mesh_terms: D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology; D004535:Ehlers-Danlos Syndrome / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D004204:Joint Dislocations / Q000000981:diagnostic imaging / Q000473:pathology; D008022:Ligaments / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D061330:Multidetector Computed Tomography / Q000379:methods*; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000473:pathology; D012421:Rupture / Q000000981:diagnostic imaging / Q000473:pathology; D012887:Skull Fractures / Q000000981:diagnostic imaging / Q000473:pathology; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000473:pathology