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Surgical and Radiologic Anatomy

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27.03.2020 | Original Article

Anatomical evaluation of the craniovertebral junction on cone-beam computed tomography images

verfasst von: Sefkan Tanrisever, Mustafa Orhan, İlhan Bahşi, Eda Didem Yalçin

Erschienen in: Surgical and Radiologic Anatomy | Ausgabe 7/2020

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Abstract

Introduction

There are many craniometric measurements that are used in evaluating craniovertebral junction (CVJ) pathologies such as basilar invagination, atlantoaxial dislocation and platybasia. Therefore, it is important to determine the normal reference range of the craniometric measurements. This study aims to determine the morphometric reference values of the bony structures in the CVJ from cone-beam computed tomography (CBCT) images of a group of South Eastern Anatolian population.

Materials and methods

The CBCT images of 300 individuals were retrospectively evaluated. 14 parameters on midsagittal and 2 parameters on the coronal plane were studied. The data were statistically evaluated.

Results

Measurement results were found as follows; the distances between odontoid process (OP) and McGregor line as 0.31 ± 3.22 mm, OP and Chamberlain line 1.06 ± 3.22 mm, OP and McRae line 5.30 ± 1.59 mm, OP and Fischgold digastric line 8.70 ± 4.12 mm, OP and Fischgold bimastoid line − 5.15 ± 4.86 mm, length of McRae line 35.58 ± 2.52 mm, atlantodental interval 1.28 ± 0.48 mm, posterior atlantodental interval 19.54 ± 2.24 mm, basion axial interval 4.01 ± 1.83 mm, basion dental interval 4.92 ± 1.77 mm, length of Modified Ranawat line 28.66 ± 2.38 mm, length of Redlund-Johnell line 35.11 ± 4.09 mm, clivus canal angle 157.62° ± 11.85°, Welcher basal angle 130.83° ± 6.29°, craniocervical tilt 126.98° ± 12.24° and Powers ratio as 0.72 ± 0.06.

Conclusion

In this study, the morphometric values were evaluated according to age and gender in individuals who did not have any radiologic anomalies. The normal reference ranges may be useful for researchers who are researching pathology in this region. It is recommended to conduct further studies with different populations to determine the normal reference range.

Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M (1999) Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine 24:1425–1434. https://doi.org/10.1097/00007632-199907150-00007 CrossRefPubMed

Adam AM (1987) Skull radiograph measurements of normals and patients with basilar impression; use of Landzert's angle. Surg Radiol Anat 9:225–229. https://doi.org/10.1007/BF02109633 CrossRefPubMed

Al Kaissi A, Kalchhauser G, Grill F, Klaushofer K (2008) Arthrogryposis multiplex congenital in a child manifesting phenotypic features resembling dysosteosclerosis/osteosclerosis malformation complex; 3DCT scan analysis of the skull base. Cases J 1:56. https://doi.org/10.1186/1757-1626-1-56 CrossRefPubMedPubMedCentral

Albert D, Block AM, Bruce BB, Haines DE, Mccloskey LJ, Mitchell RN, Moore K, Petri W, Telser AG (2012) Dorland's illustrated medical dictionary. Elsevier/Saunders, Philadelphia

Aras Y, Ünal TC (2015) Radiological evaluation of craniovertebral junction anomalies. Türk Nöroşir Derg 25:122–132

Azar FM, Canale ST, Beaty JH (2016) Campbell's operative orthopaedics e-book. Elsevier Health Sciences, Amsterdam

Bahşi I, Orhan M, Kervancıoğlu P, Yalçın ED, Aktan AM (2019) Anatomical evaluation of nasopalatine canal on cone beam computed tomography images. Folia Morphol (Warsz) 78:153–162. https://doi.org/10.5603/FM.a2018.0062 CrossRef

Batista UC, Joaquim AF, Fernandes YB, Mathias RN, Ghizoni E, Tedeschi H (2015) Computed tomography evaluation of the normal craniocervical junction craniometry in 100 asymptomatic patients. Neurosurg Focus 38:E5. https://doi.org/10.3171/2015.1.FOCUS14642 CrossRefPubMed

Bollo RJ, Riva-Cambrin J, Brockmeyer MM, Brockmeyer DL (2012) Complex Chiari malformations in children: an analysis of preoperative risk factors for occipitocervical fusion. J Neurosurg Pediatr 10:134–141. https://doi.org/10.3171/2012.3.PEDS11340 CrossRefPubMed

10.

Botelho RV, Ferreira EDZ (2013) Angular craniometry in craniocervical junction malformation. Neurosurg Rev 36:603–610. https://doi.org/10.1007/s10143-013-0471-0 CrossRefPubMedPubMedCentral

11.

Bundschuh C, Modic MT, Kearney F, Morris R, Deal C (1988) Rheumatoid arthritis of the cervical spine: surface-coil MR imaging. AJR Am J Roentgenol 151:181–187. https://doi.org/10.2214/ajr.151.1.181 CrossRefPubMed

12.

Chamberlain WE (1939) Basilar impression (platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med 11:487–496PubMedPubMedCentral

13.

Chandra PS, Goyal N, Chauhan A, Ansari A, Sharma BS, Garg A (2014) The severity of basilar invagination and atlantoaxial dislocation correlates with sagittal joint inclination, coronal joint inclination, and craniocervical tilt: a description of new indexes for the craniovertebral junction. Neurosurgery 10:621–630. https://doi.org/10.1227/neu.0000000000000470 CrossRefPubMed

14.

Chang W, Alexander MT, Mirvis SE (2009) Diagnostic determinants of craniocervical distraction injury in adults. AJR Am J Roentgenol 192:52–58. https://doi.org/10.2214/AJR.07.3993 CrossRefPubMed

15.

Chen Y, Zhuang Z, Qi W, Yang H, Chen Z, Wang X, Kong K (2011) A three-dimensional study of the atlantodental interval in a normal Chinese population using reformatted computed tomography. Surg Radiol Anat 33:801–806. https://doi.org/10.1007/s00276-011-0817-7 CrossRefPubMed

16.

Chen YF, Liu HM (2009) Imaging of craniovertebral junction. Neuroimaging Clin N Am 19:483–510. https://doi.org/10.1016/j.nic.2009.06.002 CrossRefPubMed

17.

Clark CR (2005) The cervical spine, 4th edn. Lippincott Williams and Wilkins, Philadelphia

18.

Cronin CG, Lohan DG, Mhuircheartigh JN, Meehan CP, Murphy J, Roche C (2009) CT evaluation of Chamberlain's, McGregor's, and McRae's skull-base lines. Clin Radiol 64:64–69. https://doi.org/10.1016/j.crad.2008.03.012 CrossRefPubMed

19.

Cronin CG, Lohan DG, Mhuircheartigh JN, Meehan CP, Murphy JM, Roche C (2007) MRI evaluation and measurement of the normal odontoid peg position. Clin Radiol 62:897–903. https://doi.org/10.1016/j.crad.2007.03.008 CrossRefPubMed

20.

Dash C, Singla R, Agarwal M, Kumar A, Kumar H, Mishra S, Sharma BS (2018) Craniovertebral junction evaluation by computed tomography in asymptomatic individuals in the Indian population. Neurol India 66:797–803. https://doi.org/10.4103/0028-3886.232288 CrossRefPubMed

21.

Erbengi A, Öge HK (1994) Congenital malformations of the craniovertebral junction: classification and surgical treatment. Acta Neurochir (Wien) 127:180–185. https://doi.org/10.1007/bf01808763 CrossRef

22.

Forseen SE, Borden NM (2016) Imaging anatomy of the human spine. Demos Medical Publishing, New York

23.

Frade HC, França CCNL, Nascimento JJC, Holanda MMD, Neto EJD, Neto SAA (2017) Cranio-vertebral transition assessment by magnetic resonance imaging in a sample of a northeast Brazilian population. Arq Neuropsiquiatr 75:419–423. https://doi.org/10.1590/0004-282X20170071 CrossRefPubMed

24.

Gonzalez LF, Fiorella D, Crawford NR, Wallace RC, Feiz-Erfan I, Drumm D, Papadopoulos SM, Sonntag VK (2004) Vertical atlantoaxial distraction injuries: radiological criteria and clinical implications. J Neurosurg Spine 1:273–280. https://doi.org/10.3171/spi.2004.1.3.0273 CrossRefPubMed

25.

Harris JH, Carson GC, Wagner LK (1994) Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol 162:881–886. https://doi.org/10.2214/ajr.162.4.8141012 CrossRefPubMed

26.

Henderson FC, Henderson FC, Wilson WA, Mark AS, Koby M (2018) Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review. Neurosurg Rev 41:149–163. https://doi.org/10.1007/s10143-017-0830-3 CrossRefPubMed

27.

Henderson FC, Wilson WA, Mott S, Mark A, Schmidt K, Berry JK, Vaccaro A, Benzel E (2010) Deformative stress associated with an abnormal clivo-axial angle: a finite element analysis. Surg Neurol Int 1:30. https://doi.org/10.4103/2152-7806.66461 CrossRefPubMedPubMedCentral

28.

Hinck VC, Hopkins CE, Savara BS (1961) Diagnostic criteria of basilar impression. Radiology 76:572–585. https://doi.org/10.1148/76.4.572 CrossRefPubMed

29.

Kawaida H, Sakou T, Morizono Y (1989) Vertical settling in rheumatoid arthritis. Diagnostic value of the Ranawat and Redlund-Johnell methods. Clin Orthop Relat Res 239:128–135

30.

Kim DH, Hilibrand AS (2005) Rheumatoid arthritis in the cervical spine. J Am Acad Orthop Surg 13:463–474. https://doi.org/10.5435/00124635-200511000-00006 CrossRefPubMed

31.

Kim LJ, Rekate HL, Klopfenstein JD, Sonntag VK (2004) Treatment of basilar invagination associated with Chiari I malformations in the pediatric population: cervical reduction and posterior occipitocervical fusion. J Neurosurg 101:189–195. https://doi.org/10.3171/ped.2004.101.2.0189 CrossRefPubMed

32.

Koenigsberg RA, Vakil N, Hong TA, Htaik T, Faerber E, Maiorano T, Dua M, Faro S, Gonzales C (2005) Evaluation of platybasia with MR imaging. AJNR Am J Neuroradiol 26:89–92PubMed

33.

Koller H, Robinson Y 2019 Cervical spine surgery: standard and advanced techniques. Springer International Publishing, ChamCrossRef

34.

Kwong Y, Rao N, Latief K (2011) Craniometric measurements in the assessment of craniovertebral settling: are they still relevant in the age of cross-sectional imaging? AJR Am J Roentgenol 196:W421–W425. https://doi.org/10.2214/AJR.10.5339 CrossRefPubMed

35.

Lee C, Woodring JH, Goldstein SJ, Daniel TL, Young AB, Tibbs PA (1987) Evaluation of traumatic atlantooccipital dislocations. AJNR Am J Neuroradiol 8:19–26PubMed

36.

Li G, Passias P, Kozanek M, Shannon BD, Li G, Villamil F, Bono CM, Harris M, Wood KB (2009) Interobserver reliability and intraobserver reproducibility of powers ratio for assessment of atlanto-occipital junction: comparison of plain radiography and computed tomography. Eur Spine J 18:577–582. https://doi.org/10.1007/s00586-008-0877-5 CrossRefPubMedPubMedCentral

37.

Liu K, Xie F, Wang D, Guo L, Qi Y, Tian J, Zhao B, Chhabra A (2015) Reference ranges for atlantodental interval in adults and its variation with age and gender in a large series of subjects on multidetector computed tomography. Acta Radiol 56:465–470. https://doi.org/10.1177/0284185114530284 CrossRefPubMed

38.

Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS (2015) Anatomy and biomechanics of the craniovertebral junction. Neurosurg Focus 38:E2. https://doi.org/10.3171/2015.1.FOCUS14807 CrossRefPubMed

39.

McGregor M (1948) The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol 21:171–181. https://doi.org/10.1259/0007-1285-21-244-171 CrossRef

40.

McRae DL (1953) Bony abnormalities in the region of the foramen magnum: correlation of the anatomic and neurologic findings. Acta Radiol 40:335–354. https://doi.org/10.3109/00016925309176595 CrossRefPubMed

41.

Menezes AH (2008) Craniovertebral junction database analysis: incidence, classification, presentation, and treatment algorithms. Childs Nerv Syst 24:1101–1108. https://doi.org/10.1007/s00381-008-0605-9 CrossRefPubMed

42.

Morishita Y, Falakassa J, Naito M, Hymanson HJ, Taghavi C, Wang JC (2009) The kinematic relationships of the upper cervical spine. Spine 34:2642–2645. https://doi.org/10.1097/BRS.0b013e3181b435e4 CrossRefPubMed

43.

Mzumara SS, Kimani NM, Onyambu CK (2012) Evaluating Chamberlain’s, McGregor’s, and Mcrae’s skull-base lines using multi detector computerised tomography. East Afr Med J 89:272–277PubMed

44.

Nagashima C, Kubota S (1983) Craniocervical abnormalities. Modern diagnosis and a comprehensive surgical approach. Neurosurg Rev 6:187–197. https://doi.org/10.1007/bf01743100 CrossRefPubMed

45.

Nascimento JJC, Neto EJS, Mello-Junior CF, Valença MM, Araújo-Neto SA, Diniz PRB (2019) Diagnostic accuracy of classical radiological measurements for basilar invagination of type B at MRI. Eur Spine J 28:345–352. https://doi.org/10.1007/s00586-018-5841-4 CrossRefPubMed

46.

Netto DS, Nascimento SRR, Ruiz CR (2014) Metric analysis of basal sphenoid angle in adult human skulls. Einstein (São Paulo) 12:314–317CrossRef

47.

Omercikoglu S, Altunbas E, Akoglu H, Onur O, Denizbasi A (2017) Normal values of cervical vertebral measurements according to age and sex in CT. Am J Emerg Med 35:383–390. https://doi.org/10.1016/j.ajem.2016.11.019 CrossRefPubMed

48.

Osmotherly PG, Rivett DA, Rowe LJ (2012) The anterior shear and distraction tests for craniocervical instability. An evaluation using magnetic resonance imaging. Man Ther 17:416–421. https://doi.org/10.1016/j.math.2012.03.010 CrossRefPubMed

49.

Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler JA (1979) Traumatic anterior atlanto-occipital dislocation. Neurosurgery 4:12–17. https://doi.org/10.1227/00006123-197901000-00004 CrossRefPubMed

50.

Radcliff KE, Ben-Galim P, Dreiangel N, Martin SB, Reitman CA, Lin JN, Hipp JA (2010) Comprehensive computed tomography assessment of the upper cervical anatomy: what is normal? Spine J 10:219–229. https://doi.org/10.1016/j.spinee.2009.12.021 CrossRefPubMed

51.

Ranawat CS, O'Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L (1979) Cervical spine fusion in rheumatoid arthritis. J Bone Jt Surg Am 61:1003–1010CrossRef

52.

Redlund-Johnell I, Pettersson H (1984) Radiographic measurements of the cranio-vertebral region: designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn (Stockh) 25:23–28. https://doi.org/10.1177/028418518402500105 CrossRef

53.

Reijnierse M, Dijkmans BA, Hansen B, Pope TL, Kroon HM, Holscher HC, Breedveld FC, Bloem JL (2001) Neurologic dysfunction in patients with rheumatoid arthritis of the cervical spine. Predictive value of clinical, radiographic and MR imaging parameters. Eur Radiol 11:467–473. https://doi.org/10.1007/s003300000557 CrossRefPubMed

54.

Riew KD, Hilibrand AS, Palumbo MA, Sethi N, Bohlman HH (2001) Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Jt Surg Am 83:194–200. https://doi.org/10.2106/00004623-200102000-00006 CrossRef

55.

Rojas CA, Bertozzi JC, Martinez CR, Whitlow J (2007) Reassessment of the craniocervical junction: normal values on CT. AJNR Am J Neuroradiol 28:1819–1823. https://doi.org/10.3174/ajnr.A0660 CrossRefPubMed

56.

Ross JS, Moore KR (2015) Diagnostic imaging: spine e-book. Elsevier Health Sciences, Amsterdam

57.

Sankhe SS, Kumar SK (2011) Neuroimaging in craniovertebral anomalies as seen in the tropics. Neuroimaging Clin N Am 21(879–895):ix. https://doi.org/10.1016/j.nic.2011.07.014 CrossRef

58.

Saunders WMW (1943) Basilar impression: the position of the normal odontoid. Radiology 41:589–590. https://doi.org/10.1148/41.6.589 CrossRef

59.

Schweitzer ME, Hodler J, Cervilla V, Resnick D (1992) Craniovertebral junction: normal anatomy with MR correlation. AJR Am J Roentgenol 158:1087–1090. https://doi.org/10.2214/ajr.158.5.1566672 CrossRefPubMed

60.

Smoker WRK (1994) Craniovertebral junction: normal anatomy, craniometry, and congenital anomalies. RadioGraphics 14:255–277. https://doi.org/10.1148/radiographics.14.2.8190952 CrossRefPubMed

61.

Smoker WRK, Khanna G (2008) Imaging the craniocervical junction. Childs Nerv Syst 24:1123–1145. https://doi.org/10.1007/s00381-008-0601-0 CrossRefPubMed

62.

Suchomel P, Choutka O (2011) Reconstruction of upper cervical spine and craniovertebral junction. Springer, BerlinCrossRef

63.

Tassanawipas A, Mokkhavesa S, Chatchavong S, Worawittayawong P (2005) Magnetic resonance imaging study of the craniocervical junction. J Orthop Surg (Hong Kong) 13:228–231. https://doi.org/10.1177/230949900501300303 CrossRef

64.

Vachhrajani S, Sen AN, Satyan K, Kulkarni AV, Birchansky SB, Jea A (2014) Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group. J Neurosurg Pediatr 14:425–433. https://doi.org/10.3171/2014.7.peds13591 CrossRefPubMed

65.

Wang S, Wang C, Passias PG, Li G, Yan M, Zhou H (2009) Interobserver and intraobserver reliability of the cervicomedullary angle in a normal adult population. Eur Spine J 18:1349–1354. https://doi.org/10.1007/s00586-009-1112-8 CrossRefPubMedPubMedCentral

66.

Wholey MH, Bruwer AJ, Baker HL Jr (1958) The lateral roentgenogram of the neck; with comments on the atlanto-odontoid-basion relationship. Radiology 71:350–356. https://doi.org/10.1148/71.3.350 CrossRefPubMed

67.

Yoon K, Cha SW, Ryu JA, Park DW, Lee S, Joo KB (2015) Anterior atlantodental and posterior atlantodental intervals on plain radiography, multidetector CT, and MRI. J Korean Soc Radiol 72:57–64. https://doi.org/10.3348/jksr.2015.72.1.57 CrossRef

Titel: Anatomical evaluation of the craniovertebral junction on cone-beam computed tomography images
verfasst von: Sefkan Tanrisever
Mustafa Orhan
İlhan Bahşi
Eda Didem Yalçin
Publikationsdatum: 27.03.2020
Verlag: Springer Paris
Erschienen in: Surgical and Radiologic Anatomy / Ausgabe 7/2020
Print ISSN: 0930-1038
Elektronische ISSN: 1279-8517
DOI: https://doi.org/10.1007/s00276-020-02457-z

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Anatomical evaluation of the craniovertebral junction on cone-beam computed tomography images

Abstract

Introduction

Materials and methods

Results

Conclusion

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Springer Medizin

Abstract

Introduction

Materials and methods

Results

Conclusion

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