Diagnostic determinants of craniocervical distraction injury in adults

Craniocervical distraction injury is a class of injuries that involve the skull base, the atlas, and the axis. Although these injuries often are overt imaging and clinical findings, the injury can be masked during unreliable physical examinations and difficult to identify during diagnostic imaging. The goal of this study was to identify on coronal and sagittal CT multiplanar reformations precise measurements and qualitative relations between anatomic landmarks that can help in establishing the diagnosis of craniocervical distraction injury.

We performed a retrospective review of the cases of 35 patients with craniocervical distraction injury admitted to our trauma center from 2000 to 2006. Two independent radiologists made several qualitative and quantitative anatomic assessments on reformatted CT images through the craniocervical junctions (skull base through C2) of the 35 patients and of 50 other patients sustaining blunt trauma who were discharged without findings of cervical spinal injury. Logistic regression, recursive partitioning, and multivariate analysis were performed in an attempt to find measurements that differentiated the groups.

Among the patients with craniocervical distraction injury, statistically significant positive correlations were found in several measurements, including midline occiput-C1 spinolaminar distance (p=0.0016), midline C1-C2 spinolaminar distance (p<0.0001), basion-dens distance (p<0.0001), sum of condylar displacement (p=0.0002), and basion-posterior axial line distance (p<0.0001).

Several quantitative parameters on sagittal and coronal multiplanar CT reformations can be used to differentiate patients with craniocervical distraction injury from patients without this injury.