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Chiropractic Research Review

Imaging the Craniovertebral Junction with Open MRI

The craniovertebral junction, consisting of the occiput (C0), atlas (C1), axis (C2), and supporting ligaments, possesses a unique design that allows for distinct motion patterns. Motion and stability of this junction are commonly assessed with lateral flexion-extension in anteroposterior lateral bending radiographs.

However, direction of motion can be limited to flexion-extension with standard imaging procedures, and head and neck positioning is generally accomplished using wedges or pillows rather than by use of a precise positioning device.

The purpose of this study was to design and build a positioning device to allow for magnetic resonance imaging (MRI) of the cervical spine in rotation, lateral bending, flexion and extension. Specifically, MRI was performed on 10 male and 10 female asymptomatic subjects in a horizontally open 0.23T imager. The positions of C0, C1 and C2 were measured, motion patterns between segments were analyzed, and lateral displacement of the atlas during lateral bending and cranial migration distance during flexion-extension were assessed.

Results: Motion patterns of the craniovertebral junction during rotation did not differ between men and women, but a small gender difference was noted in lateral bending at C1-C2. In men, the position of C1 during flexion-extension was more extended in relation to C0 and C2 than in women.

The authors conclude that open MRI allows for imaging of the upper cervical spine during flexion, extension, rotation and lateral bending. They suggest that separate reference values be used for men and women when assessing the relationship between C0-C1 and C1-C2.

Karhu JO, Parkkola RK, Komu MES, et al. Kinematic magnetic resonance imaging of the upper cervical spine using a novel positioning device. Spine, Oct. 1, 1999:24(19), pp2046-56.

Chiropractic Research Review

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