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- Title
Utility of Anterior Atlantodens Interval Widening on Cervical Spine CT for Assessing Transverse Atlantal Ligament Injury.
- Authors
Fiester, Peter; Orallo, Peaches; Soule, Erik; Rao, Dinesh; Tavanaiepour, Daryoush
- Abstract
Study Design: Retrospective, cross-sectional Objectives: To identify trauma patients with confirmed tears of the transverse atlantal ligament on cervical MRI and measure several parameters of atlanto-axial alignment on cervical CT, including the anterior atlantodens interval, to determine which method is most sensitive in predicting transverse atlantal ligament injury. Methods: Adult trauma patients who suffered a transverse atlantal ligament tear on cervical MRI were identified retrospectively. The cervical CT and MRI exams for these patients were reviewed for the following: anterior and lateral atlantodens interval widening, lateral C1 mass offset, C1–C2 rotatory subluxation, and transverse atlantal ligament injuries on cervical MRI. Results: Twenty-six patients were identified with a tear of the transverse atlantal ligament on cervical MRI. Twelve percent of these patients demonstrated an anterior dens interval measuring greater than 2 mm, 26% of patients demonstrated lateral mass offset of C1 on C2 (average offset of 2.4 mm), 18% of patients demonstrated an asymmetry greater than 1 mm between the left and right lateral atlantodens interval, and one patient demonstrated atlanto-axial rotation measuring greater than 20%. Ten patients had an accompanying C1 burst fracture and eight patients had a C2 fracture. One patient demonstrated widening of the atlanto-occipital joint space greater than 2 mm indicative of craniocervical dissociation injury. Conclusions: An anterior atlantodens interval measuring greater than 2 mm is an unreliable methodology to screen trauma patients for transverse altantal ligament injuries and atlanto-axial instability. Moreover, C1 lateral mass offset, lateral atlantodens asymmetry, and atlanto-axial rotation were all poor predictors of transverse atlantal ligament tears.
- Subjects
LIGAMENT injuries; CERVICAL vertebrae; ANTERIOR longitudinal ligament; ATLANTO-occipital joint; LIGAMENTS; MEDICAL screening
- Publication
Global Spine Journal, 2023, Vol 13, Issue 8, p2319
- ISSN
2192-5682
- Publication type
Article
- DOI
10.1177/21925682221081211