Atlantodental joint widening obscured by earrings and motion artifact

Case contributed by Matt Skalski
Diagnosis certain

Presentation

Whiplash injury. Neck pain.

Patient Data

Age: 30 years

Anterior translation of C1 with atlantodental joint space (ADI) widening and anterior offset of the posterior tubercle relative to the expected spinolaminar line alignment.

The dens and anterior tubercle are outlined in purple, highlighting the ADI which is widened behind earring artifacts that partially obscure its visualization. The spinolaminar line of the C1 posterior tubercle is shown in blue relative to its expected location near the dotted line, which extends from the C2 spinolaminar line to the opisthion, further confirming the suspected ADI widening.

Case Discussion

This case highlights several key points. The first is the importance of jewelry/clothing artifacts in potentially limiting image assessment. It also illustrates the importance of reviewing lines of alignment (posterior body/George's, spinolaminar, McGregor, etc) before signing off on a study as you may discover otherwise obscured or non-obvious instability patterns, basilar invagination, etc. The lateral image in this case also has a small amount of motion blur which further limits assessment.

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