“CRANIO-VERTEBRAL JUNCTION ANOMALIES- SPECTRUM ON MAGNETIC RESONANCE IMAGING”

Abstract

OBJECTIVE: This prospective study was done in the Department of Radiodiagnosis, King George Medical University, Lucknow, over the period of one year from September 2007 to July 2008. The purpose of this study was to evaluate the spectrum of cranio-vertebral junction anomalies on Magnetic resonance imaging (MRI). Fourty patients for whom MRI of cervical spine inc METHODS: luding cranio-vertebral junction was done for varying symptoms and showed imaging features of cranio-vertebral junction anomalies were selected for the study. Results were presented in numerical and percentage forms. There were 34 males and 6 female patients i RESULTS: n the age range of 3-60 years. Maximum number of patients were in the age group between 11-20 years (18 patients-45%) followed by age group of 21-30 years (7 patients-17.5%). Most common presenting symptom was weakness of both upper & lower limbs seen in 16 patients (40 %) followed by neck pain & stiffness in 15 patients (37.5%) and sensory symptoms in 11 patients (27.5%). Weakness of lower limbs, lower cranial nerve dysfunction & bladder bowel symptoms were the least common presenting symptoms seen only in 1 patient (2.5%). Atlanto-axial instability was the most common abnormality present in 30 patients (75%). Occipitilisation of atlas was the second most common abnormality seen in 20 patients (50%) and basilar invagination; third most common abnormality seen in 14 patients (35%). Other less commonly found abnormalities were ossiculum terminale (in 6 patients-15%), platybasia (in 5 patients-12.5%), aplasia of atlas arches(in 3 patients-7.5%), os odontoideum(in 3 patients-7.5%), segmentation failure of C2-C3 (in 3 patients7.5%), clivus segmentation (in 2 patients-5%). Atlanto-axial fusion(in 1 patient 2.5%) & hypoplasia of dens (in 1 patient 2.5%). Most common associated feature was syrinx formation found in 9 patients (22.5%). Out of 40 patients, 34 patient had developmental anomalies (85%) while 6 patients had acquired causes, including tubercular in 5 patients-12.5% & rheumatoid arthritis in 1 patient -2.5%. Myelopathic changes were found in 28 patients (70%) out of which motor symptoms were present in 25 patients (89.29%) .