title: Comparison of CT versus MRI measurements of transverse atlantal ligament integrity in craniovertebral junction injuries. Part 2: A new CT-based alternative for assessing transverse ligament integrity.
abstract: OBJECTIVE The rule of Spence is inaccurate for assessing integrity of the transverse atlantal ligament (TAL). Because CT is quick and easy to perform at most trauma centers, the authors propose a novel sequence of obtaining 2 CT scans to improve the diagnosis of TAL impairment. The sensitivity of a new CT-based method for diagnosing a TAL injury in a cadaveric model was assessed. METHODS Ten human cadaveric occipitocervical specimens were mounted horizontally in a supine posture with wooden inserts attached to the back of the skull to maintain a neutral or flexed (10°) posture. Specimens were scanned in neutral and flexed postures in a total of 4 conditions (3 conditions in each specimen): 1) intact (n = 10); either 2A) after a simulated Jefferson fracture with an intact TAL (n = 5) or 2B) after a TAL disruption with no Jefferson fracture (n = 5); and 3) after TAL disruption and a simulated Jefferson fracture (n = 10). The atlantodental interval (ADI) and cross-sectional canal area were measured. RESULTS From the neutral to the flexed posture, ADI increased an average of 2.5% in intact spines, 6.25% after a Jefferson fracture without TAL disruption, 34% after a TAL disruption without fracture, and 25% after TAL disruption with fracture. The increase in ADI was significant with both TAL disruption and TAL disruption and fracture (p < 0.005) but not in the other 2 conditions (p > 0.6). Changes in spinal canal area were not significant (p > 0.70). CONCLUSIONS This novel method was more sensitive than the rule of Spence for evaluating the integrity of the TAL on CT and does not increase the risk of further neurological damage.
authors.affiliation: Spinal Biomechanics Laboratory and.
authors.forename: Luis
authors.initials: L
authors.lastname: Perez-Orribo
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Samuel
authors.initials: S
authors.lastname: Kalb
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Snyder
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Forrest
authors.initials: F
authors.lastname: Hsu
authors.affiliation: Spinal Biomechanics Laboratory and.
authors.forename: Devika
authors.initials: D
authors.lastname: Malhotra
authors.affiliation: Spinal Biomechanics Laboratory and.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Lefevre
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Ali M
authors.initials: AM
authors.lastname: Elhadi
authors.affiliation: Spinal Biomechanics Laboratory and.
authors.forename: Anna G U S
authors.initials: AG
authors.lastname: Newcomb
authors.affiliation: Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Theodore
authors.affiliation: Spinal Biomechanics Laboratory and.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Crawford
mesh_terms: D000328:Adult; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D006801:Humans; D008022:Ligaments / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D012680:Sensitivity and Specificity; D012886:Skull / Q000000981:diagnostic imaging / Q000293:injuries*; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: ADI = atlantodental interval; CVJ = craniovertebral junction; TAL = transverse atlantal ligament; atlantoaxial overhang; atlantodental interval; atlas fracture; axis fracture; measurement; transverse atlantal ligament; trauma