C1-C2 "subluxation" - normal cervical anatomy at maximum head rotation

Case contributed by Dr Jörgen Strömberg

Presentation

Otherwhise healthy male with no symptoms from the cervical spine.

Patient Data

Age: 35 year-old
Gender: Male

The atlas is rotated approximately 45 degrees to the left in relation to the axis, with subsequent anterior and posterior "subluxation" of the right and left facets respectively. In comparison, there is very little rotation between the base of the skull and the atlas. The same applies for the lower levels of the cervical spine.

Case Discussion

The subject of this examination was a healthy volunteer, and the objective was to demonstrate the normal anatomy of the cervical spine at maximum head rotation.

The experiment was carried out in the aftermath of an actual patient case. The patient in question had been found on the floor at home, unable to communicate what had happened. Neurological deficits lead to a head CT with findings consistent with an acute cerebri media infarction. However, in the lowermost images there was also a suspected subluxation in the C1-C2 level. Since details of the incident were unclear and the area only partially imaged, subsequent imaging of the cervical spine was performed. This failed to demonstrate any pathology, and the relation between C1 and C2 had been normalised. 

The experiment demonstrates the great range of movement at this level of the cervical spine. This is important to consider, especially in patients where imaging for some reason has been carried out with the patient's head rotated, and there is low clinical suspicion of cervical spine injury. 

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Case information

rID: 42483
Case created: 22nd Jan 2016
Last edited: 24th Jan 2016
Inclusion in quiz mode: Included

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