CCI is the diagnosis of abnormal structural laxity (excess movement) in the junction between the skull and the first cervical vertebrae (C0-C1).
AAI is the diagnosis of abnormal structural laxity (excess movement) in the junction between the first two cervical vertebras (C1-C2).
This increased mobility of the craniocervical and/or atlantoaxial junction may cause neurological symptoms, either due to compression at the level of the brainstem and/or cervical spine or from the compression/distortion of the Vertebral Artery.
Upright scans (MRI or CBCT scan) of the craniocervical junction in neutral, flexion, and extension provides essential weight-bearing imaging to diagnose for Craniocervical Instability.
Performing a supine (standard, laying down) MRI or CT scan does not provide an accurate diagnosis for most patients and may be dismissed as a normal MRI or CT scan.
Atlantoaxial instability is best diagnosed by comparing neutral and rotational imaging of the first two cervical levels.
We use angle measurements and distances between bone elements of the craniocervical junction and also investigate the existence of indirect signs of craniocervical mobility.
The most commonly used measurements in the radiological evaluation are CXA, Grabb, BDI, BAI.
Imaging is a crucial aspect of diagnosing instability, comparing the congruence of the clinical symptoms with the imaging.
*Abbrevations: BDI: basion dens interval, CXA: clivo axial angle, BAI: basion-axial interval
Surgery should always be the last option considered. However, surgical fusion is currently the only proven treatment for advanced cases of craniocervical instability. Posterior fusion stabilization surgery fuses the skull to the unstable spinal levels using titanium-blend hardware, though in some cases it’s necessary to use Chrome-Cobalt Alloy. The fusion is further strengthened by affixing bone to the fused area with donor bone and artificial bone material. Traction is also applied to release compression on the brain stem.
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