CT-functional diagnostics of the rotatory instability of upper cervical spine, I:​ an experimental study on cadavers

Dvorak, Jiri; Panjabi, Manohar; Gerber, Markus; Wichmann, Werner

Affiliations

¹Departments of Neurology and Biomechanics, University of Berne, Berne, Switzerland

²Department of Rheumatology, Clinic W. Schulthess, Zurich, Switzerland

³Department of Orthopaedics and Rehabilitation, Yale University, The School of Medicine, New Haven

⁴Department of Neuroradiology, University of Zurich, Zurich, Switzerland

Abstract and keywords

Twelve specimens of the upper cervical spine were functionally examined by using radiography, cineradiography and computerized tomographic (CT) scan. The range of rotation was measured from CT images after maximal rotations to both sides. The left alar ligament was then cut and the examination repeated. The alar and transverse ligaments could be differentiated on CT images in axial, sagittal, and coronal views. Rotation at occiput-atlas was 4.35° to the right and 5.9 ° to the left and at atlas-axis it was 31.4° to the right and 33° to the left. After one-sided lesion of the alar ligament, there was an overall increase of 10.8 ° or 30% of original rotation to the opposite side, divided about equally between the occiput - atlas and the atlas-axis. It is concluded that a lesion (irreversible overstretching or rupture of alar ligaments) can result in rotatory hypermobility or instability of the upper cervical spine.

Keywords: upper cervical spine; rotary instability; alar ligaments

Links

DOI: 10.1097/00007632-198704000-00001

PubMed: 3589813

WoS: A1987H133400001

History

Received: 1986-04-23

Accepted: 1986-04-23

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Cited By (13)

Year	Entry
2004	Sundararajan S, Prasad P, Demetropoulos CK, Tashman S, Begeman PC, Yang KH, King AI. Effect of head-neck position on cervical facet stretch of post mortem human subjects during low speed rear end impacts. Stapp Car Crash J. 2004;48:331-372. SAE 2004-22-0015.
2000	Bogduk N, Mercer S. Biomechanics of the cervical spine, I: normal kinematics. Clin Biomech (Bristol, Avon). November 2000;15(9):633-648.
1995	Myers BS, Winkelstein BA. Epidemiology, classification, mechanism, and tolerance of human cervical spine injuries. Crit Rev Biomed Eng. 1995;23(5-6):307-409.
2012	Fice JB, Cronin DS. Investigation of whiplash injuries in the upper cervical spine using a detailed neck model. J Biomech. April 5, 2012;45(6):1098-1102.
1991	Dvorak J, Panjabi MM, Novotny JE, Antinnes JA. In vivo flexion/extension of the normal cervical spine. J Orthop Res. November 1991;9(6):828-834.
1991	Panjabi M, Dvorak J, Crisco J III, Oda T, Hilibrand A, Grob D. Flexion, extension, and lateral bending of the upper cervical spine in response to alar ligament transections. J Spinal Disord. June 1991;4(2):157-167.
1994	Barnsley L, Lord S, Bogduk N. Whiplash injury. Pain. September 1994;58(3):283-307.
1987	Dvorak J, Hayek J, Zehnder R. CT-functional diagnostics of the rotatory instability of upper cervical spine, II: an evaluation on healthy adults and patients with suspected instability. Spine. October 1987;12(8):726-731.
1988	Panjabi M, Dvorak J, Duranceau J, Yamamoto I, Gerber M, Rauschning W, Bueff HU. Three-dimensional movements of the upper cervical spine. Spine. July 1988;13(7):726-730.
1988	Dvorak J, Froehlich D, Penning L, Baumgartner H, Panjabi MM. Functional radiographic diagnosis of the cervical spine: flexion/extension. Spine. July 1988;13(7):748-755.
1990	Goel VK, Winterbottom JM, Schulte KR, Chang H, Gilbertson LG, Pudgil AG, Gwon JK. Ligamentous laxity across c0–c1–c2 complex: axial torque-rotation characteristics until failure. Spine. October 1990;15(10):990-996.
2003	Alderink GJ. Three-Dimensional Kinematic Analysis of the Thorax in Standing and Sitting [PhD thesis]. East Lansing, MI: Michigan State University; 2003.
2005	Sundararajan S. Effect of Head-Neck Position on Cervical Facet Stretch of Post Mortem Human Subjects During Low Speed Rear End Impacts [PhD thesis]. Detroit, MI: Wayne State University; 2005.