CVJ Abnormality, General
Julia Crim, MD
DIFFERENTIAL DIAGNOSIS
Common
Bone Trauma
Odontoid Fracture, C2
Burst Fracture, C2
Hangman’s Fracture, C2
Jefferson C1 Fracture
Occipital Condyle Fracture
Os Odontoideum
Congenital Neural Abnormalities
Chiari 1 Malformation
Chiari 2 Malformation
Congenital Bone and Ligament Abnormalities
Achondroplasia
Craniovertebral Junction Variants
Trisomy 21
Mucopolysaccharidoses
Arthritis
Osteoarthritis
Rheumatoid Arthritis
Juvenile Idiopathic Arthritis
Spondyloarthropathy, Seronegative
CPPD
Soft Tissue Calcification or Ossification
Calcific Tendinitis, Longus Coli
Spondyloarthropathy, Seronegative
OPLL
CPPD
Extramedullary Mass
Metastases
Lymphoma
Plasmacytoma
Pannus from Rheumatoid Arthritis
Abscess, Epidural, Paravertebral
Osteomyelitis, C1-C2
Nasopharyngeal Carcinoma
Neurofibromatosis Type 1
Schwannoma
Paraganglioma
Meningioma
Intramedullary Mass
Syringomyelia
Chiari 1 Malformation
Chiari 2 Malformation
Hemangioblastoma, Spinal Cord
Pediatric Brainstem Glioma
Bone Mass
Metastases
Multiple Myeloma
Osteomyelitis, C1-C2
Chondrosarcoma
Chordoma (Usually Clivus)
Aneurysmal Bone Cyst
Cranial Settling, Platybasia and Basilar Invagination, Acquired
Paget Disease
Rheumatoid Arthritis, Adult
Osteomalacia/Rickets
Less Common
Rotary Subluxation, C1-2
Atlanto-Occipital Dislocation
Grisel Syndrome
Carotid Dissection/Pseudoaneurysm
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
Hint: Differentiate trauma vs. bony congenital variant
Soft tissue swelling usually evident in trauma
Cortication of bone indicates nonacute trauma
Os odontoideum thought to be nonunited fracture, not congenital variant
Hint: Watch for mass adjacent to dens
Pannus from RA: Dens eroded, no calcification
Seronegative spondyloarthropathy: Like RA, plus enthesophytes, joint fusion
Juvenile inflammatory arthropathy: Like adult RA or seronegative spondyloarthropathy
Usually involves multiple levels in cervical spine
Growth disturbance characteristic
CPPD: Calcifications, cysts in bone
Infection: Usually involves disc space
Tuberculosis involves disc space later in course of infection
OPLL, osteoarthritis: No bony erosion
Tumor: Origin in bone, meninges or cord
Hint: Watch for heterogeneous high signal in bone marrow without cortical breakthrough
Myeloma
Lymphoma
Metastases
Helpful Clues for Common Diagnoses
Types of C2 fractures
Odontoid Fracture, C2
Type I: Obliquely oriented through tip
Type II: Horizontally oriented through base
Type III: Really a fracture of body; horizontally oriented, through body and below base of dens
Burst Fracture, C2
Axial load injury
Extends through posterior cortex of vertebral body
Hangman’s Fracture, C2
Hyperflexion or hyperextension, usually from MVA
Traumatic spondylolisthesis of C2
Fracture through C2 pedicles
Usually see focal kyphosis and anterolisthesis at C2-C3
Effendi type I: Traumatic spondylolisthesis isolated
Effendi type II: Also disruption of C2-C3 disc
Effendi type III: Also disruption of C2-C3 facet joints
Os Odontoideum
Chronic nonunited fracture
Congenital Bone and Ligament Abnormalities
May be multiple
May be isolated, detected as incidental finding in adulthood
Often cause adjacent premature degeneration
Trisomy 21
Spinal stenosis
Instability occiput-C1 and C1-C2
Unlike RA, no erosion of dens
Osteoarthritis
Common at craniocervical junction
Involves synovial articulations: Facet joints, dens/C1 articulation
Dens and anterior arch of C1 develop osteophytes, sclerosis best seen on CTRelated posts:
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