Fiester Peter, Rao Dinesh, Soule Erik, Jenson Matthew, Patel Jeet
Neuroradiology, University of Florida College of Medicine, Jacksonville, USA.
Interventional Radiology, University of Florida College of Medicine, Jacksonville, USA.
Cureus. 2021 Apr 2;13(4):e14254. doi: 10.7759/cureus.14254.
Background In the absence of frank craniocervical dissociation, there is a lack of consensus regarding what patterns of craniocervical junction ligamentous injuries require occipital-cervical fusion. This study was undertaken to examine the integrity of the craniocervical junction ligaments and analyze clinical outcomes in patients who underwent occipital-cervical fusion for craniocervical junction injury. Methods Adult patients requiring occipital-cervical fusion were identified retrospectively utilizing keyword searches in cervical computed tomography and magnetic resonance imaging reports between 2012 and 2020 using Nuance mPower software (Nuance, Burlington, MA). The cervical magnetic resonance imaging examinations for these patients were reviewed for craniocervical ligamentous injury by two neuroradiologists. Descriptions of craniocervical junction injuries, demographic information, clinical history, surgical management, and global outcomes were recorded. Results Nine adult patients were identified with an acute, post-traumatic craniocervical junction injury requiring occipital-cervical fusion. All nine patients demonstrated a ligamentous tear in at least one of the four major craniocervical junction ligaments - the occipital condylar-C1 capsular ligaments, alar ligaments, tectorial membrane, and posterior atlantooccipital membrane. The tectorial membrane was the most commonly torn ligament followed by the alar ligament(s), posterior atlantooccipital membrane, and capsular ligament(s). There was wide variability in the number of major craniocervical junction ligaments torn, ranging from one ligament to all four ligaments. Four patients suffered persistent neurologic deficits following surgery. Conclusion Craniocervical injury is best evaluated by cervical magnetic resonance imaging. In the absence of overt craniocervical dissociation, we propose that an injury of the tectorial membrane in the adult population may indicate patients with significant craniocervical instability, possibly necessitating occipital-cervical fusion.
在没有明显颅颈分离的情况下，对于哪些颅颈交界区韧带损伤模式需要枕颈融合，目前尚无共识。本研究旨在检查颅颈交界区韧带的完整性，并分析因颅颈交界区损伤接受枕颈融合手术患者的临床结局。方法：利用Nuance mPower软件（Nuance，伯灵顿，马萨诸塞州），通过对2012年至2020年间颈椎计算机断层扫描和磁共振成像报告进行关键词搜索，回顾性确定需要枕颈融合的成年患者。由两名神经放射科医生对这些患者的颈椎磁共振成像检查进行颅颈韧带损伤评估。记录颅颈交界区损伤的描述、人口统计学信息、临床病史、手术治疗及整体结局。结果：确定9例成年患者因急性创伤性颅颈交界区损伤需要枕颈融合。所有9例患者在四个主要颅颈交界区韧带（枕髁-C1关节囊韧带、翼状韧带、覆膜和寰枕后膜）中至少有一处韧带撕裂。覆膜是最常撕裂的韧带，其次是翼状韧带、寰枕后膜和关节囊韧带。颅颈交界区主要韧带撕裂的数量差异很大，从一条韧带到四条韧带均有。4例患者术后仍存在持续性神经功能缺损。结论：颈椎磁共振成像最适合评估颅颈损伤。在没有明显颅颈分离的情况下，我们认为成年人群中覆膜损伤可能提示颅颈严重不稳定，可能需要枕颈融合。
