Evaluation of Cervicomedullary Compression Around the Craniovertebral Junction: Commentary on “Measurement of Deformity at the Craniovertebral Junction: Correlation of Triangular Area and Myelopathy”

Abstract

The craniovertebral junction (CVJ) is the region around the skull base and the upper cervical spine (atlas and axis), along with its neurovascular components, including the brain stem, spinal cord, vertebral artery, and venous plexus. [1][2][3][4][5][6] The stability of CVJ is dependent on a robust ligamentous complex and the shape of the bony structures, which are also responsible for much of the axial rotation (C1-2 joint) and flexion-extension movements (C0-1 and C1-2 joint). 7,8 CVJ pathologies are usually rare and can result in progressive deformity, myelopathy, severe neck pain, and functional disability, such as difficulty swallowing. 3,[9][10][11][12] The most common causes are rheumatoid arthritis, trauma, neoplasm, infection, and congenital bony malformation. These CVJ pathologies may alter the quality of life because of the neck pain, disabling headache, dysphagia, and myelopathy. 12,13 In most cases, standard radiographs, computed tomography, and magnetic resonance imaging typically conduct the proper diagnosis of CVJ pathology. However, no one-single method has been recom mended to properly diagnose CVJ pathology due to the overlying structures on lateral plain radiographs. Ambiguous landmarks lead to low reliability or consistency for confirming basilar invagination (BI). [14][15][16] Accordingly, we must establish a more reliable and consistent method for diagnosing CVJ pathologies.Many methods for diagnosing BI and CVJ pathology may imply that choosing just one method in clinical circumstances is complicated. These measurements can show variable results due to multiple reasons. First, anatomical landmarks may be ambiguous, thus leading the interpreter to measure different results. Second, measurement errors can be made by the interpreter himself or on the radiographs. The lack of confidence in anatomic landmarks can cause unreliable results, and it is hard to obtain absolute true-lateral radiographs in every patient.Variations in measurement may lead to a different type of treatment. Therefore, we need to determine how reliable and reproducible these measurements are. 16