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The atlanto-occipital joint may be dislocated, especially from violent accidents such as traffic collisions. [1] This may be diagnosed using CT scans or magnetic resonance imaging of the head and neck. [1] Surgery may be used to fix the joint and any associated bone fractures. [1] Neck movement may be reduced long after this injury. [1]
The under surface of the jugular process is rough, and gives attachment to the Rectus capitis lateralis muscle and the lateral atlanto-occipital ligament; from this surface an eminence, the paramastoid process, sometimes projects downward, and may be of sufficient length to reach, and articulate with, the transverse process of the atlas.
The atlanto-occipital joint allows the head to nod up and down on the vertebral column. The dens acts as a pivot that allows the atlas and attached head to rotate on the axis, side to side. The atlas's chief peculiarity is that it has no body, [3] which has fused with the next vertebra. [4]
Several indirect measurements on CT can be used to assess ligamentous integrity at the craniocervical junction. The Wackenheim line, a straight line extending along the posterior margin of the clivus through the dens, should not intersect the dens on plain film, with violation of this relationship raising concern for basilar invagination.
The clivus is an important landmark for checking for anatomical atlanto-occipital alignment. When viewed on a lateral C-spine radiograph, the clivus forms a line which, if extended, is known as Wackenheim's clivus line. Wackenheim's clivus line should pass through the dens of the axis or be tangential to it. [9]
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Craniocervical instability (CCI) is a medical condition characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and the top two vertebra, known as C1 and C2.