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It is the lateral head tilt, not head rotation, causing an asymmetry of the odontoid-lateral mass interspace


Guenkel, S; Scheyerer, M J; Osterhoff, G; Wanner, G A; Simmen, H-P; Werner, C M L (2016). It is the lateral head tilt, not head rotation, causing an asymmetry of the odontoid-lateral mass interspace. European Journal of Trauma and Emergency Surgery, 42(6):749-754.

Abstract

OBJECTIVE Asymmetry in odontoid-lateral mass interspace in trauma patients is a common finding that regularly leads to additional diagnostic work-up, since its dignity is not entirely clear. There is little evidence in the literature that atlantoaxial asymmetry is associated with C1-C2 instability or (sub) luxation. Asymmetry in odontoid-lateral mass interspace seems to occur occasionally in healthy individuals and patients suffering a cervical spine injury. Congenital abnormalities in odontoid-lateral mass asymmetry may mimic an atlantoaxial asymmetry. The center of C1-C2 rotation is based in the peg of dens axis; therefore, a C1-C2 rotational influence seems unlikely. So far, no study examined the influence of C0-C1-C2 tilt to an asymmetry in odontoid-lateral mass interspace. SUBJECTS AND METHODS In order to determine if rotation or tilt influences the lateral atlantodental interval (LADI) and to estimate physiologic values, we examined 300 CT scans of the cervical spine. RESULTS The mean LADI was 3.57 mm and the mean odontoid-lateral mass asymmetry was 1.0 mm. Head position during CT examination was found to be rotated in 39 % of the cases in more than 5°. Subsequent mean C0/C2 rotation was 4.6°. There was no significant correlation between atlantoaxial asymmetry and head rotation (p = 0.437). The average tilt of C0-C1-C2 was found to be 2°. We found a significant correlation between tilt of C0-C1-C2 and asymmetry in odontoid-lateral mass interspace (p = 0.000). CONCLUSION We conclude that an atlantoaxial asymmetry revealed in CT scans of the cervical spine occurs occasionally. Since head tilt correlates with an atlantoaxial asymmetry, it is crucial to perform cervical spine CT scans in a precise straight head position.

Abstract

OBJECTIVE Asymmetry in odontoid-lateral mass interspace in trauma patients is a common finding that regularly leads to additional diagnostic work-up, since its dignity is not entirely clear. There is little evidence in the literature that atlantoaxial asymmetry is associated with C1-C2 instability or (sub) luxation. Asymmetry in odontoid-lateral mass interspace seems to occur occasionally in healthy individuals and patients suffering a cervical spine injury. Congenital abnormalities in odontoid-lateral mass asymmetry may mimic an atlantoaxial asymmetry. The center of C1-C2 rotation is based in the peg of dens axis; therefore, a C1-C2 rotational influence seems unlikely. So far, no study examined the influence of C0-C1-C2 tilt to an asymmetry in odontoid-lateral mass interspace. SUBJECTS AND METHODS In order to determine if rotation or tilt influences the lateral atlantodental interval (LADI) and to estimate physiologic values, we examined 300 CT scans of the cervical spine. RESULTS The mean LADI was 3.57 mm and the mean odontoid-lateral mass asymmetry was 1.0 mm. Head position during CT examination was found to be rotated in 39 % of the cases in more than 5°. Subsequent mean C0/C2 rotation was 4.6°. There was no significant correlation between atlantoaxial asymmetry and head rotation (p = 0.437). The average tilt of C0-C1-C2 was found to be 2°. We found a significant correlation between tilt of C0-C1-C2 and asymmetry in odontoid-lateral mass interspace (p = 0.000). CONCLUSION We conclude that an atlantoaxial asymmetry revealed in CT scans of the cervical spine occurs occasionally. Since head tilt correlates with an atlantoaxial asymmetry, it is crucial to perform cervical spine CT scans in a precise straight head position.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
04 Faculty of Medicine > University Hospital Zurich > Clinic for Reconstructive Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2016
Deposited On:05 Jan 2016 14:35
Last Modified:08 Dec 2017 16:32
Publisher:Springer
ISSN:1863-9933
Publisher DOI:https://doi.org/10.1007/s00068-015-0602-0
PubMed ID:26660673

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