The Craniocervical Junction: Observations regarding the Relationship between Misalignment, Obstruction of Cerebrospinal Fluid Flow, Cerebellar Tonsillar Ectopia, and Image-Guided Correction

The craniocervical junction is the most complex area of the spinal axis. Due to its complexity it is extremely vulnerable to injuries to the soft tissue stabilizing ligaments and membranous structures. Proper imaging in this area is an essential key to proper diagnosis directing towards the most appropriate and safe treatment options when injury occurs. Misalignments of C₀-C1, C1-C2 brought on by head or neck trauma can manifest in different outcomes. Some of those outcomes can affect or cause neural compromise, and/or some may contribute to cerebrospinal fluid (CSF) flow obstruction as well as arteriovenous compromise. C1 misalignment may also contribute to distention of the cerebellar tonsils (cerebellar tonsillar ectopia), i.e. down through the foramen magnum due to caudal tension by way of dentate ligament pathological stress on the spinal cord leading to obstruction of the normal flow of CSF. Mechanical compression of the jugular vein by the transverse process of C1 has been found to lead to obstruction of outgoing venous blood flow. Such obstruction has been found in chronic cerebral spinal venous insufficiency which has been observed in neurodegenerative brain diseases such as multiple sclerosis. Image-Guided Atlas TreatmentTM (IGATTM) has been shown to be a method of gentle correction of misalignment of C₀-C1, C1-C2, resulting in improved CSF flow as well as venous outflow. Image-guided atlas treatment utilizes advanced dynamic upright MRI as the means of evaluating misalignments at the craniocervical junction, and the images obtained are used to calculate the appropriate alignment vectors to correct the misalignment. Post-correction advanced upright MRI images are then used to validate the appropriate realignment of C₀-C1, C1-C2 to establish improvement in proper CSF as well as arteriovenous flow.