High energy trauma results in a tear of the tectorial membrane and alar ligament at the craniocervical junction
Lateral Neck X-ray
Powers Ratio = greater than 1
basion to C1 arch
opisthion to C1 arch
Cranio‐cervical fusion with internal fixation
Damage to transverse ligament allows C1 (atlas) to move forward resulting in an increased atlanto dens interval (ADI)
More common in Down Syndrome, Rheumatoid Arthritis
Atlanto-Dens Interval
> 3.5mm considered unstable
> 10mm indicates surgery in RA
posterior occipitocervical/C1–C2 fusion after transoral odontoidectomy or periodontoid tissue release
Grisel Syndrome – inflammatory or infectious process of the atlanta-axial joint results in atlanto-axial subluxation
dynamic CT is the gold standard
CT Spine that shows reverse hamburger sign
Cervical orthosis or external immobilization (6-12 weeks)
CT Spine that shows reverse hamburger sign
Emergent closed reduction if neuro deficits, if not then get MRI
Works Referenced