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Remodeling changes are also noted in the anterior C1 ring ſt and os. The posterior C1 ring ﬈ is hypoplastic and resides within the spinal canal, just below the foramen magnum. (Right) Sagittal FLAIR (os avis, same patient) reveals abnormal T2 signal within the cervical spinal cord at the C1 level, reflecting injury related to atlantoaxial instability and mild C1 ring ſt hypoplasia. 25% pediatric population Natural History & Prognosis • Usually gradual onset of neurological symptoms with localizing signs; some patients asymptomatic throughout life • Occasionally, neurological presentation is fulminant → quadriplegia, sudden death • Undetected anomalies at risk for injury during minor trauma, anesthesia • Early diagnosis permits treatment before symptoms or permanent neurological sequelae Treatment • Conservative approach initially unless unstable or neural deficits present ○ Traction, cervical orthosis, activity restriction • Symptomatic, refractory to conservative management ○ Skeletal traction to distinguish reducible from irreducible abnormalities, relieve symptoms preoperatively ○ Correction of underlying biomechanical abnormality with decompression ± fusion DIAGNOSTIC CHECKLIST Consider • Look for combinations of anomalies based on known association patterns • Impact of diagnosis must be customized to individual patient to develop best treatment approach Image Interpretation Pearls • Dynamic flex-extend imaging determines stability, reducibility of abnormality • CT with reformats valuable for evaluating osseous abnormalities SELECTED REFERENCES 1.

The distal reference point is the posterior superior aspect of the sacrum. There is a positive number if C7 plumb line falls anterior to the reference point, and a negative number if it falls posterior to the reference. Selected References 1. 2. 3. 4. 5. 6. 7. In spinal cord injury patients, midline T1 and T2 images provide an objective, quantifiable, and reliable assessment of cord compression that cannot be defined by CT alone. 8. Maximum Cord Compression (%) • = 1-(di/[(da+db)/2]) x 100% 9. AP cord diameter at the normal levels immediately above and below the level of injury and at the level of maximum cord compression is defined.

Facet joints are oriented in the coronal plane. (Right) Image through the pedicle level of the thoracic spine: The coronal orientation of the facet joints are well identified in this section ﬈. The pedicles are thin and gracile, with adjacent rib articulations. 7 Congenital and Genetic Disorders: Congenital Normal Anatomy (Left) Graphic shows lumbar body from above. Large, sturdy lumbar bodies connect to thick pedicles and transversely directed transverse processes. Facets maintain oblique orientation favoring flexion/extension.

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