Interrelationship Between Craniocervical Dissociation Spectrum Injuries and Atlantoaxial Instability on Trauma...

Area of Science:

• Orthopedic Surgery
• Neurosurgery
• Radiology

Background:

• Craniocervical dissociation injuries (CDSI) involve skull base to C1-C2 osteoligamentous damage.
• Management varies from external immobilization to occipital cervical fusion based on instability risk.
• Atlantoaxial instability (AAI) from transverse atlantal ligament (TAL) integrity may indicate greater craniocervical junction (CCJ) instability.

Purpose of the Study:

• To investigate the frequency of associated major and minor ligamentous injuries in patients with acute transverse atlantal ligament (TAL) tears.
• To determine if TAL tears correlate with concurrent injuries to other major craniocervical ligaments.

Main Methods:

• Retrospective review of adult trauma patients with acute midsubstance TAL tears on cervical MRI.
• Analysis of cervical CT and MRI for additional traumatic findings.
• Recording of demographic, treatment, and outcome data.

Main Results:

• Twenty-nine patients with acute TAL tears were identified.
• 31% had at least one other major craniocervical ligament tear; 14% had two.
• Minor ligament injuries (AAOMc, PAOMc) were frequent (76%).

Conclusions:

• Multiple major craniocervical ligamentous injuries are uncommon in patients with isolated transverse atlantal ligament tears.
• TAL tears may not always be associated with extensive CCJ ligamentous disruption.