E1531. My Neck, My Back: Must Know Trauma Facts - A Review of Craniocervical Junction Injuries
  1. Chinky Patel; University of Tennessee Health Science Center
  2. Asif Jamal; University of Tennessee Health Science Center
  3. Ashley Cahoon; University of Tennessee Health Science Center
  4. Jenson Ma; University of Tennessee Health Science Center
  5. Alexander Rich; University of Tennessee Health Science Center
  6. Bhumin Patel; University of Tennessee Health Science Center
  7. Muhammad Afzal; University of Tennessee Health Science Center
Cervical spine injuries in the emergency setting often lead to significant morbidity and mortality. One-third of these cases involve the craniocervical junction (CCJ). The CCJ comprises an essential anatomic group of structures that provides movement and stability to the cervical spine. Severe injuries are known to result in death on site; however, as the acute management of patients in the trauma setting continues to improve, there is an increase in such encountered injuries. It is crucial to understand the osseous and ligamentous anatomical components of the CCJ, to learn about the various types of injuries, and recognize their imaging appearance to aid timely treatment and prevent delayed neurological deficits in patients who survive.

Educational Goals / Teaching Points
This exhibit will review the components of CCJ anatomy and their clinical importance. The various patterns of injury and classification will also be highlighted, such as occipital condyle fractures, atlantoccipital dissocation, fractures of the atlas and transverse ligament rupture, atlantoaxial distraction, and alar ligament rupture as well as neurovascular injury. Examples of cases encountered at our trauma center will be presented. Understanding the CCJ and imaging in the trauma setting is useful to identify unstable patients for better management.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The CCJ comprises the occiput, first two cervical vertebrae, lateral atlantooccipital and atlantoaxial articulations, and various ligaments. The transverse and alar ligaments are the major stabilizing ligaments. Although measurements on plain radiography have been established to evaluate the CCJ, MDCT is the screening modality of choice for evaluating cervical spine injuries. Features of injury on CT include joint incongruity, hematoma, vertebral artery injury, capsular swelling, and rarely, fractures through the cranial nerve canals. MRI is a valuable adjunct for the evaluation of associated soft tissue and ligamentous injuries. Features on MRI include prevertebral fluid, fluid-filled joint spaces, ligamentous disruption, and cord injury.

The CCJ is a complex anatomical landmark with multiple components and is often challenging to evaluate, especially in the trauma setting. It is crucial to be aware of the anatomy, various patterns, and classification of CCJ injuries and their respective imaging appearance for adequate evaluation and subsequent management. MDCT is superior to plain radiography for the identification of these injuries. The ACR recommends MRI in patients whose neurological status cannot be fully evaluated within 48 hours of injury. It better demonstrates associated soft tissue, ligamentous and spinal cord injuries. Earlier imaging is favored to maximize the sensitivity of MRI due to increased water content from edema. Prompt diagnosis of CCJ injuries is crucial for effective treatment and minimizing long-term neurological sequelae.