The craniovertebral junction (CVJ) is a neurovascular structure architecture that separates the skill base from the subaxial. It is the most complex region of the cervical spine and it provides an extension, cranial flexion, and axial rotation pattern. The wide range of movements in the cervical region makes it vulnerable to instability and injury. The unique anatomical features of the CVJ make children more prone to injury of CVJ than adults. The signs and symptoms of CVJ injury patients are weakness, spasticity, low hairline, short neck, high arched palate, torticollis, and neck movement restriction. Stability is provided by ligamentous and osseous supports. Craniovertebral junction (CVJ) disorder can result in cranial nerve compression, obstructive hydrocephalus, and vertebral artery compression.
The craniovertebral junction is formed by the combination of occipital condyles, atlas (C1), Axis (C2) vertebrae, and their articulations. In case, any malformation of these structures will lead to CVJ anomaly. It may be because of a congenital, acquired, or developmental cause. The malformation of the CVJ can be classified in to:
Malformation of the occipital sclerotome will lead to platybasia, occipital condylar hypoplasia, atlas assimilation, remnants of proatlas, and segmentation anomaly of the clivus.
Malformations of the atlas vertebra will result in bifid arches, atlas assimilation, and hypoplasia of the atlas.
Malformation of axis and odontoid process atlantoaxial fusion, os odontoideum, and odontoid dysplasia.
Before getting the proper treatment, they have to undergo an X-ray and MRI scan of the head and neck. Surgery is the best option to prevent or treat neurological symptoms. Conservative management also used to keep the symptoms in control.
The subaxial cervical spine has bony anatomy and ligamentous anatomy. Injuries to the subaxial cervical can result in bony, soft tissue, or a combination of both. Subaxial cervical spine injuries are very common. Some of the injuries are minor ligamentous strain, fracture-dislocation with bone, severe spinal cord injury, and ligament failure. Understanding in detail about anatomy, biomechanics, epidemiology, and classification of the subaxial cervical spine is very essential.
The fracture patterns will vary based on the mechanism such as compression fracture, burst fracture, flexion teardrop fracture, facet dislocation, and facet fracture.
The treatment of the subaxial cervical spine is constantly evolving, The development of cervical instrumentation and the proliferation of cervical fusion techniques have opened the way for changes in the management of cervical trauma. Injuries like collar immobilization will take up to 6 to 12 weeks to get normal.