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ECR 2019 / C-0873
Bridging defects-Radio-anatomical review of cranio-vertebral junction anomalies
Congress: ECR 2019
Poster No.: C-0873
Type: Educational Exhibit
Keywords: CT, Conventional radiography, Musculoskeletal system, Head and neck, Foetal imaging, Localisation, Developmental disease
Authors: G. Ilangovan1, R. G. Reddy2; 1Chennai, TA/IN, 2Chennai/IN


Anatomy of CVJ:

Articular anatomy: upper surfaces of C1 lateral masses are cup like  or concave which fit in to the ball and socket configuration, united by articular capsules surrounding the atlanto-occipital joint & by anterior & posterior atlanto-occipital membranes.



Atlas and axis- four synovial joints between atlas and axis

  •  two median- front and back of dens (pivot variety)
  • two lateral-between opposing articular facets(plane variety), rotation is up to 900 and approximately half occurs at A-A joint


Ligamentous anatomy: principal stabilising ligaments of C1(figure.1)


1.Transverse atlantal ligament

2.Alar ligaments

Secondary stabilising ligaments

1.Apical ligaments

2.Anterior and posterior A-O membranes

3.Tectorial membrane

4.Ligamentum flavum

5.Capsular ligaments


Craniometric landmarks

( figure.2 and3)

Craniometric measurement

Anatomic landmarks

Normal values and clinical implications

Chamberlains line

Line joining basion to opisthion

Dens projecting >6mm above it indicates basilar invagination

Mc Rae line

Line joining anterior and posterior margins of foramen magnum

Odontoid tip lying above this line is indicative of type A basilar invagination

Wecken-Heim clivus base line

Line drawn along clivus and extending into upper cervical canal, it should tangent to odontoid

If it intersects the body of dens anterior craniocervical dislocation is present and vice versa

Clivus canal angle

The angle formed by the wecken-Heim line and a line constructed along the posterior surface of the axis body and odontoid process

Normal is 150-180 if<150 ventral cord compression may occur

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