The most important structural relationship to evaluate in this view is alignment of the lateral masses of C1 with respect to the odontoid process. Hu J, Yang KH, Chou CC, King AI. 1. (B) Normal oblique projection shows the normal appearance of the laminae as shingles on a roof forming a regular elliptical curve with equal interlaminar spaces. The primary feature of the myelopathy resulting from atlantoaxial dislocation is an acute or slowly progressive quadriplegia, which usually begins during childhood or young adult life. Fig. The odontoid or 'peg' projection is an AP projection of C1 (atlas) and C2 (axis). Posterior to the odontoid is the low signal transverse ligament complex. First described in 1863 (postmortem specimen) and called os odontoideum in 1886 by Giacomini. Fracture along the attachment of the odontoid process to the body of C2 is known as a type II fracture, and fracture of the odontoid inferior to its attachment to the body of C2 that includes part of the body of C2 is known as a type III odontoid fracture. [Medline]. If you log out, you will be required to enter your username and password the next time you visit. Spine J. Odontoid fracture (Figures 1 and 9) Highly unstable. asymmetry of the articular spaces between the lateral masses of C1 and the body All cases of odontoid hypoplasia or absence have a higher than normal risk for cervical spinal cord compression. Radiol Clin North Am. 11:346-352. the clinician should establish a process or order they follow each time. The pattern of instability, with posterior atlanto-axial subluxation in extension (B), reduced in flexion (A), is common. Surgical procedures are often followed by halo immobilization if not rigid. If there is any asymmetry between the articular spaces (mainly lines 3) this would be most concerning for either a Jefferson (or Burst) fracture of C1 or a dens fracture (or Odontoid fracture) of C2 or possible transverse ligament injury. 34(4):549-53; discussion 553-4. Posteroanterior dens–C1 ring interval (PADI) less than 13 mm; sagittal translation of C1 on C2 during flexion-extension views of greater than 5 mm; rotational instability greater than 20 degrees. First, assess if the film is Adequate. Cervical myelomeningocele is exceptionally uncommon and is not ordinarily part of the differential diagnosis of neonatal hypotonia because of the obvious dorsal defect. The lateral radiographs show odontoid abnormality, but any instability is best shown with the active flexion–extension views with forward shifting of the axis (C1) on C2 with flexion. [Medline]. FREDERIC SHAPIRO, in Pediatric Orthopedic Deformities, 2001. Stiell IG, Wells GA, Vandemheen KL, et al. Copyright © 2000 W.B. 34(24):2646-53. Moira Davenport, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency MedicineDisclosure: Nothing to disclose. 2000 Jul 13. An odontoid view must be obtained to differentiate this benign fracture from a Jefferson fracture. Common injuries to the upper cervical spine include: Being able to read and recognize common landmarks when interpreting an open mouth odontoid view is important in determining who has an unstable condition that may warrant more aggressive intervention.
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