Imaging the cv junction.part 2. himadri s das

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Imaging the cv junction.part 2. himadri s das

  1. 1. ODONTOID ABNORMALITIES Os Odontoideum :  Refers to an independent osseous structure lying cephalad to the axis body in the location of odontoid process.  Cruciate lig incompetence & AAS common  May mimic type II odontoid # Os odontoideum Type II fracture Well corticated, convex upper margin of C1 Hypertrophied & rounded Sharp, jagged uncorticated margin of axis Normal ant arch C1 Moves with ant arch C1 Does not
  2. 2. ODONTOID ABNORMALITIES Persistent Ossiculum Terminale :  Also called Bergman Ossicle.  Results from failure of fusion of the terminal ossicle to the rest of odontoid  Normally fusion occurs by 12 yrs of age  Stable anomaly when isolated with normal height of dens
  3. 3. Persistent Ossiculum Terminale May mimic type I odontoid # (avulsion of terminal ossicle) : difficult to differentiate at times.
  4. 4. ODONTOID ABNORMALITIES Os Odontoideum :  Refers to an independent osseous structure lying cephalad to the axis body in the location of odontoid process.  Cruciate lig incompetence & AAS common  May mimic type II odontoid # Os odontoideum Type II fracture Well corticated, convex upper margin of C1 Hypertrophied & rounded Sharp, jagged uncorticated margin of axis Normal ant arch C1 Moves with ant arch C1 Does not
  5. 5. Os odontoideum
  6. 6. Os odontoideum- Dystopic types
  7. 7. TRAUMA : Atlas and Occiput Jefferson fracture :  involves the anterior &posterior arches of atlas with instability  Isolated # of post arch due to hyper-extn injury
  8. 8. ODONTOID FRACTURE  Type I : avulsion # of tip of odontoid by the alar ligament  Type II : transverse # at base f Dens  Type III : # of superior portion of axis body with extn through one or both articular facets
  9. 9. ODONTOID FRACTURE
  10. 10. CVJ-traumatic AAD
  11. 11. CVJ- trauma
  12. 12. CVJ-trauma
  13. 13. CVJ-trauma
  14. 14. HANGMAN FRACTURE # of neural arch of C2 that occurs in sudden hyperextension injuries like windshield injuries and in judicial hanging
  15. 15. CHIARI MALFORMATIONS  Chiari I- elongated, peg like cerebellar tonsils are displaced inferiorly through Foramen Magnum  Syrinx in 20-40%  25% show BI, KlippelFeil syndrome & atlantooccipital assimilation
  16. 16. ACM I with syrinx
  17. 17. ACM-II
  18. 18. CHIARI MALFORMATIONS Chiari IIherniation of vermis, IV ventricle & medulla into spinal canal with kinking and displacement of normal structures. Chiari IIIf/o Chiari II with occipital encephalocele.
  19. 19. Inflammatory, Arthritic & Infectious Disorders  Rheumatoid Arthritis (most common)  Psoriatic arthritis, osteoarthritis, CPPD etc.  Tuberculosis  Fungal infections
  20. 20. RHEUMATOID ARTHRITIS  Cervical spine involved in 44-88% patients. Degree       of Cx spine involvement correlates with the duration & severity of disease. Anterior AAS (MC, 50-70%) Sub axial subluxation (20-25%) BI (less common, 10-15%),most dangerous Posterior & Rotatory AAS rare Neurological impairment in 11-58% cases Vascular compression of basilar, spinal arteries
  21. 21. RHEUMATOID ARTHRITIS
  22. 22. CVJ-rheumatoid
  23. 23. RA- Sub axial Subluxation  2nd MC subluxn in RA (MC is ant AAS). Occurs d/t facet joint arthritis, ligamentous laxity & disc involvement that lead to ‘step ladder’ deformity  Normal Cx sag diameter at C3-7 is 14-23 mm. <14 mm is critical for cord compression (10mm cord, 2mm dura & 2mm CSF)
  24. 24. TUBERCULOSIS Tuberculosis of atlanto-axial region is rare (<1% of cases of spinal TB) It may present withi) retropharyngeal abscess ii) AAD/AAI iii) varying grades of bone destruction
  25. 25. TUBERCULOSIS
  26. 26. TUBERCULOSIS
  27. 27. Koch’s
  28. 28. CVJ Koch’s Pre ATT Post ATT
  29. 29. Tuberculoma:
  30. 30. TUMORS: Astrocytoma
  31. 31. Multiple myeloma
  32. 32. Neurofibroma
  33. 33. Intradural Lipomatosis
  34. 34. CVJ-meningioma
  35. 35. Tumors: Meningioma
  36. 36. MISC I : OPLL with Cord Myelomalacia
  37. 37. Misc II :Demyelinating
  38. 38. 3D-MDCT IN CVJ
  39. 39. 3D-VRT
  40. 40. 3D-VRT
  41. 41. THANK YOU!

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