Alar ligament calcification
This patient presented with complaints of neck pain and pulsatile left hemicranial headaches — no history of trauma.
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There is a corticated ovoid calcification, measuring about 4.2 x 5.1 x 6.5 mm, located between the odontoid tip and the right occipital condyle, along the course of the right alar ligament. There were no other calcifications in the other ligaments of the craniovertebral junction.
There was no evidence of fractures in the odontoid process, the occipital condyles, or the neural arch of the atlas. The spinal canal appeared normal, and there was no dislocation C1-C2.
6 case question available
The alar ligaments arise from both sides of the tip of the odontoid process and run obliquely cephalad to insert on the medial surface of the occipital condyles 1,2,3. Calcification of the alar ligament is rare 1-4. This condition should be differentiated from fractures of craniovertebral junction, as well as from crowned dens syndrome 1,4.
The present case illustrates the typical features of focal calcification in the right alar ligament, associated with neck pain.
- 1. Sim KB, Park JK. A nodular calcification of the alar ligament simulating a fracture in the craniovertebral junction. (2006) AJNR. American journal of neuroradiology. 27 (9): 1962-3. Pubmed
- 2. Soubai RB, Tahiri L, Abourazzak FZ, Tizniti S, Harzy T. Calcification of the alar ligament of the cervical spine in a patient with rheumatoid arthritis. (2012) The Pan African medical journal. 13: 41. Pubmed
- 3. Yuka Kobayashi, J. Mochida, Ikuo Saito, Sizuka Matui, Eiren Toh. Calcification of the alar ligament of the cervical spine: imaging findings and clinical course. (2001) Skeletal Radiology. 30 (5): 295. doi:10.1007/s002560100325 - Pubmed
- 4. NAOHO TAKIZAWA, ATSUSHI NOMURA, YOSHIRO FUJITA. Rare Cause of Nuchal Pain: Calcification of the Alar Ligament. (2016) The Journal of Rheumatology. 43 (1): 177. doi:10.3899/jrheum.150905 - Pubmed