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Background: Detailed study of the craniovertebral junction (CVJ) is necessary to completely understand the mechanism of its flexion and extension. Materials and methods: One cadaver head was sectioned in the sagittal plane. Also, in 22 volunteers, examined using the multislice computed tomography (MSCT), 14 parameters and 2 angles were measured in the neutral position, flexion and extension. Results: The obtained measurements showed the anterior part of the occiput to move inferiorly in flexion, and the anterior atlas arch and the tip of the dens to get closer to the basion. At the same time, the opisthion moves superiorly, but the cervical spine bends anteriorly. Consequently, the dens-opisthion diameter and the opisthion-posterior atlas arch distance slightly decrease in length, whilst the arches of the atlas (C1), axis (C2) and C3 vertebra become more distant. Following extension, the posterior part of the occiput moves inferiorly, so that the basion-dens tip, the basion-axis arch, and the basion-posterior atlas arch distances increase in length. In contrast, the distances of the C1–C3 arches decrease in length. The angle between the foramen magnum and the dens tip decreases 1.620 on average in flexion, but increases 3.230 on average in extension. The angle between the axis body and the opisthion also decreases in flexion (mean, 3.360) and increases in extension (mean, 6.570). Among the congenital anomalies, a partial agenesis of the posterior atlas arch was revealed (4.5%), as well as an anterior dehiscence of the C1 foramen transversarium (13.6%). Conclusions: The mentioned measurements improved our understanding of the CVJ biomechanics. The obtained data can be useful in the evaluation of the CVJ instability caused by trauma, congenital anomalies and certain spine diseases. (Folia Morphol 2017; 76, 1: 100–109)
Background: The aim was to examine the position of the brain stem and cervical cord following the neck flexion and extension. Materials and methods: The serial sagittal T2-weighted magnetic resonance imaging (MRI) sections of the cervical cord and brain stem were made in 6 volunteers. The images were mainly used to measure certain distances and angles of the brain stem and cervical cord in the neutral position, and then following the head and neck flexion and extension. Results: The measurements showed that the pons is slightly closer to the clivus following the neck flexion; the medulla oblongata is somewhat distant to the basion but closer to the odontoid process. At the same time, the spino-medullary angle diminishes in size. On the other hand, the upper cervical cord slightly approaches the posterior wall of the spinal canal, the lower cervical cord is closer to the anterior wall, while the angle between them is significantly larger in size. After the cervical cord extension, the rostral pons is somewhat distant to the clivus, whereas the caudal pons and the medulla are slightly closer to the clivus and the basion. At the same time, the spino-medullary angle diminishes in size. The cervical cord is mainly closer to the posterior wall of the spinal canal, whilst its angle is significantly smaller. Conclusions: The obtained results regarding the brain stem and cervical cord motion can be useful in the kinetic MRI examination of certain congenital disorders, degenerative diseases, and traumatic injuries of the craniovertebral junction and the cervical spine. (Folia Morphol 2016; 75, 4: 439–447)
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