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Pediatrics
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Spine
Trauma
Craniocervical Junction Injuries
Craniocervical Junction Injuries
Luke L. Linscott, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          • Diagnostic Checklist

            TERMINOLOGY

            • Definitions

              • Craniocervical junction (CCJ) injuries: Traumatic injury to upper cervical region: Occiput to C2
                • Much more common in 1st decade than in teens/adults

            • Types of Pediatric Craniocervical Junction Injuries

              • Atlantooccipital dissociation (AOD)
                • a.k.a. atlantooccipital dislocation, occipitocervical dissociation
              • Atlantoaxial dissociation (AAD)
                • a.k.a. atlantoaxial dislocation
              • Jefferson fracture (C1 ring)
              • Odontoid (C2) fracture
              • Hangman's (C2) fracture
              • Atlantoaxial rotatory fixation (AARF)
              • Spinal cord injury without radiographic abnormality (SCIWORA)

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Nonvascular Interventions

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            CLINICAL ISSUES

                            • Presentation

                              • Demographics

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Consider

                                      Selected References

                                      1. Beckmann NM et al: Accuracy of craniocervical measurements on CT for identifying partial or complete craniocervical ligament injuries in pediatric patients. Skeletal Radiol. 50(1):159-69, 2021
                                      2. Fiester P et al: Pediatric retroclival epidural hematoma in the acute trauma setting: a sign of tectorial membrane stripping injury. AJR Am J Roentgenol. 216(6):1641-8, 2021
                                      3. Beckmann NM et al: Epidemiology and imaging classification of pediatric cervical spine injuries: 12-year experience at a level 1 trauma center. AJR Am J Roentgenol. 214(6):1359-68, 2020
                                      4. McAllister AS et al: Emergent imaging of pediatric cervical spine trauma. Radiographics. 39(4):1126-42, 2019
                                      5. Goldstein HE et al: Classification and management of pediatric craniocervical injuries. Neurosurg Clin N Am. 28(1):73-90, 2017
                                      6. Corcoran B et al: Application of normative occipital condyle-C1 interval measurements to detect atlanto-occipital injury in children. AJNR Am J Neuroradiol. 37(5):958-62, 2016
                                      7. Smith P et al: Normal development and measurements of the occipital condyle-C1 interval in children and young adults. AJNR Am J Neuroradiol. 37(5):952-7, 2016
                                      8. Dorney K et al: Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma. J Trauma Acute Care Surg. 79(5):822-7, 2015
                                      9. Hannon M et al: Pediatric cervical spine injury evaluation after blunt trauma: a clinical decision analysis. Ann Emerg Med. 65(3):239-47, 2015
                                      10. Vachhrajani S et al: Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group. J Neurosurg Pediatr. 14(4):425-33, 2014
                                      11. Astur N et al: Traumatic atlanto-occipital dislocation in children: evaluation, treatment, and outcomes. J Bone Joint Surg Am. 95(24):e194(1-8), 2013
                                      12. Gargas J et al: An analysis of cervical spine magnetic resonance imaging findings after normal computed tomographic imaging findings in pediatric trauma patients: ten-year experience of a level I pediatric trauma center. J Trauma Acute Care Surg. 74(4):1102-7, 2013
                                      13. Henry M et al: A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury. Childs Nerv Syst. 29(8):1333-8, 2013
                                      14. Booth TN: Cervical spine evaluation in pediatric trauma. AJR Am J Roentgenol. 198(5):W417-25, 2012
                                      15. Chung S et al: Trauma association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: consensus guidelines. J Trauma. 70(4):873-84, 2011
                                      16. Junewick JJ: Pediatric craniocervical junction injuries. AJR Am J Roentgenol. 196(5):1003-10, 2011
                                      17. Leonard JC et al: Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med. 58(2):145-55, 2011
                                      18. Junewick JJ: Cervical spine injuries in pediatrics: are children small adults or not? Pediatr Radiol. 40(4):493-8, 2010
                                      19. Bertozzi JC et al: Evaluation of the pediatric craniocervical junction on MDCT. AJR Am J Roentgenol. 192(1):26-31, 2009
                                      20. Junewick JJ et al: Occult injury of the pediatric craniocervical junction. Emerg Radiol. 16(6):483-8, 2009
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Definitions

                                                  • Craniocervical junction (CCJ) injuries: Traumatic injury to upper cervical region: Occiput to C2
                                                    • Much more common in 1st decade than in teens/adults

                                                • Types of Pediatric Craniocervical Junction Injuries

                                                  • Atlantooccipital dissociation (AOD)
                                                    • a.k.a. atlantooccipital dislocation, occipitocervical dissociation
                                                  • Atlantoaxial dissociation (AAD)
                                                    • a.k.a. atlantoaxial dislocation
                                                  • Jefferson fracture (C1 ring)
                                                  • Odontoid (C2) fracture
                                                  • Hangman's (C2) fracture
                                                  • Atlantoaxial rotatory fixation (AARF)
                                                  • Spinal cord injury without radiographic abnormality (SCIWORA)

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Nonvascular Interventions

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                CLINICAL ISSUES

                                                                • Presentation

                                                                  • Demographics

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Consider

                                                                          Selected References

                                                                          1. Beckmann NM et al: Accuracy of craniocervical measurements on CT for identifying partial or complete craniocervical ligament injuries in pediatric patients. Skeletal Radiol. 50(1):159-69, 2021
                                                                          2. Fiester P et al: Pediatric retroclival epidural hematoma in the acute trauma setting: a sign of tectorial membrane stripping injury. AJR Am J Roentgenol. 216(6):1641-8, 2021
                                                                          3. Beckmann NM et al: Epidemiology and imaging classification of pediatric cervical spine injuries: 12-year experience at a level 1 trauma center. AJR Am J Roentgenol. 214(6):1359-68, 2020
                                                                          4. McAllister AS et al: Emergent imaging of pediatric cervical spine trauma. Radiographics. 39(4):1126-42, 2019
                                                                          5. Goldstein HE et al: Classification and management of pediatric craniocervical injuries. Neurosurg Clin N Am. 28(1):73-90, 2017
                                                                          6. Corcoran B et al: Application of normative occipital condyle-C1 interval measurements to detect atlanto-occipital injury in children. AJNR Am J Neuroradiol. 37(5):958-62, 2016
                                                                          7. Smith P et al: Normal development and measurements of the occipital condyle-C1 interval in children and young adults. AJNR Am J Neuroradiol. 37(5):952-7, 2016
                                                                          8. Dorney K et al: Outcomes of pediatric patients with persistent midline cervical spine tenderness and negative imaging result after trauma. J Trauma Acute Care Surg. 79(5):822-7, 2015
                                                                          9. Hannon M et al: Pediatric cervical spine injury evaluation after blunt trauma: a clinical decision analysis. Ann Emerg Med. 65(3):239-47, 2015
                                                                          10. Vachhrajani S et al: Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group. J Neurosurg Pediatr. 14(4):425-33, 2014
                                                                          11. Astur N et al: Traumatic atlanto-occipital dislocation in children: evaluation, treatment, and outcomes. J Bone Joint Surg Am. 95(24):e194(1-8), 2013
                                                                          12. Gargas J et al: An analysis of cervical spine magnetic resonance imaging findings after normal computed tomographic imaging findings in pediatric trauma patients: ten-year experience of a level I pediatric trauma center. J Trauma Acute Care Surg. 74(4):1102-7, 2013
                                                                          13. Henry M et al: A retrospective comparison of CT and MRI in detecting pediatric cervical spine injury. Childs Nerv Syst. 29(8):1333-8, 2013
                                                                          14. Booth TN: Cervical spine evaluation in pediatric trauma. AJR Am J Roentgenol. 198(5):W417-25, 2012
                                                                          15. Chung S et al: Trauma association of Canada Pediatric Subcommittee National Pediatric Cervical Spine Evaluation Pathway: consensus guidelines. J Trauma. 70(4):873-84, 2011
                                                                          16. Junewick JJ: Pediatric craniocervical junction injuries. AJR Am J Roentgenol. 196(5):1003-10, 2011
                                                                          17. Leonard JC et al: Factors associated with cervical spine injury in children after blunt trauma. Ann Emerg Med. 58(2):145-55, 2011
                                                                          18. Junewick JJ: Cervical spine injuries in pediatrics: are children small adults or not? Pediatr Radiol. 40(4):493-8, 2010
                                                                          19. Bertozzi JC et al: Evaluation of the pediatric craniocervical junction on MDCT. AJR Am J Roentgenol. 192(1):26-31, 2009
                                                                          20. Junewick JJ et al: Occult injury of the pediatric craniocervical junction. Emerg Radiol. 16(6):483-8, 2009