Assessment and Diagnosis of Trauma in the High Cervical Spine Using Dissection, Radiography, Computed Tomography and Magnetic Resonance Imaging

Abstract

Cervical spine trauma, particularly that occurring at the craniocervical junction (CCJ), is the cause of a significant number of deaths each year. Although some forms of injury within the high cervical spine will be obvious during routine external and internal examination procedures, others cannot be diagnosed without advanced methods. The anatomy of the CCJ is complex and notoriously difficult to evaluate at autopsy. While specialized autopsy techniques allow thorough evaluation of this region, they are inconsistently understood and performed. Furthermore, although radiography has long been a mainstay of forensic pathology practice, it is not routinely utilized to assess for cervical spine trauma. As advanced radiology techniques become more regularly available in a postmortem setting (computed tomography [CT] and magnetic resonance [MR] imaging), forensic pathologists are offered additional tools that facilitate accurate diagnoses in the high cervical spine. Fundamental to the appropriate use and interpretation of autopsy and radiologic techniques is an understanding of the involved anatomy. The structures within the CCJ, advanced dissection methods, and fundamentals of cervical spine radiology are reviewed in this manuscript. Where available, autopsy evaluation of the CCJ will be complemented by radiography, CT, and MR imaging. In some circumstances, dissection and/or autopsy could be supplanted by the use of postmortem CT and MR scanning.