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Joseph Junewick, MD FACR
over 9 years ago
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Atlanto-occipital Subluxation

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 8 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: MR
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8 year old involved in high speed head-on motor vehicle accident.

Case Images


Atlanto-occipital Subluxation


MR – Sagittal and axial T2 images show cervicomedullary edema/contusion related to total disruption of the craniocervial junction. Note 1) discontinous anterior atlanto-occipital ligament, 2) elevated tectorial membrane with retroclival hematoma, 3) atlanto-occipital subluxation with blood-fluid level in the atlanto-occipital joints, and 4) precervical and posterior paraspinous edema.


The craniocervical junction is vulnerable to injury in children because of incomplete maturation of stabilizing ligaments, atlanto-occipital joints, muscles and disproportionately large heads. Broad continuations of the anterior longitudinal (anterior atlanto-occipital membrane), posterior longitudinal ligament (tectorial membrane) and interspinous ligament (suboccipital membrane) provide sagittal and coronal stabilization. The atlanto-occipital joints deepen with age. The joint capsules and alar ligaments also contribute to stability of the atlanto-occipital joints. Muscle and ligament strength increase with age. When craniocervical stabilization fails, the cervicomedullary junction prone to injury.


Junewick JJ. Pediatric craniocervical junction injuries. AJR (2011); 196: 1003-1010.


Grant Young

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