Login to MyKarger

New to MyKarger? Click here to sign up.

Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

The Craniocervical Syndrome and MRI

Editor(s): Smith F.W. (London) 
Dworkin J.S. (Melville, N.Y.) 
Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66

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

Rosa S.a · Baird J.W.b

Author affiliations

aPrivate Chiropractic Practice, Rock Hill, N.Y., USA; bPrivate Chiropractic Practice, Markham, Ont., Canada

Corresponding Author

Dr. Scott Rosa

230 Rock Hill Drive

Rock Hill, NY 12775 (USA)

E-Mail drscottrosa@hvc.rr.com

Do you have an account?

Login Information

Contact Information

I have read the Karger Terms and Conditions and agree.


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.

© 2015 S. Karger AG, Basel


  1. Harrison DE, Calliet MD, Harrison DD, Troyanovich ST, Harrison SO: A review of biomechanics of the central nervous system - part II: spinal cord strains from postural loads. J Manipulative Physiol Ther 1999;22:322-332.
  2. Rossitti S: Biomechanics of the pons-cord tract and its enveloping structures: an overview. Acta Neurochir 1993;124:144-152.
  3. Debernardi A, D'Aliberti G, Talamonti G, Villa F, Piparo M, Collice M: The craniovertebral junction area and the role of the ligaments and membranes. Neurosurgery 2011;68:291-301.
  4. Eriksen K: Upper Cervical Subluxation Complex: a Review of the Chiropractic and Medical Literature. Philadelphia, Lippincott Williams & Wilkins, 2003.
  5. Alix ME, Bates DK: A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle. J Manipulative Physiol Ther 1999;22:534-539.
  6. Cheng JC, Chau WW, Guo X, Chan YL: Redefining the magnetic resonance imaging reference level of the cerebellar tonsil. Spine 2003;28:815-818.
  7. Freeman M, Rosa S, Harshfield D, Smith F, Bennett R, Centeno C, Kornel E, Nystrom A, Heffez D, Kohles S: A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Injury 2010;24:988-994.
  8. Jinkins JR, Dworkin JS, Green CA, Greenhalgh JF, Gianni M, Gelbien M, Wolf RB, Damadian J, Damadian RV: Upright, weight-bearing, dynamic-kinetic MRI of the spine pMRI/kMRI. Rivista Neurorudiol 2002;15:333-356.
  9. Weishaupt D, Boxheimer L: Magnetic resonance imaging of the weight-bearing spine. Semin Musculoskelet Radiol 2003;7:277-286.
  10. Kaale BR, Krakenes J, Albreksten G, Wester K: Head position and impact direction in whiplash injuries: associations with MRI-verified lesions of ligaments and membranes in the upper cervical spine. J Neurotrauma 2005;22:1294-1302.
  11. Croft A: Whiplash: The Epidemic. San Diego, Spine Research Institute of San Diego, 1996.
  12. Elliot J, Jull G, Noteboom JT, Darnell R, Galloway G, Gibbon W: Fatty infiltration in the cervical extensor muscles in persistent whiplash-associated disorders - a magnetic resonance imaging analysis. Spine 2006;31:E847-E855.
  13. Wan MJ, Nomura H, Tator CH: Conversion to symptomatic Chiari I malformation after minor head or neck tauma. Neurosurgery 2008;63:748-753.
  14. Milhorat TH, Chou M, Trinidad EM, Kula RW, Mandel M, Wolpert C, Speer M: Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999;44:1005-1017.
  15. Tew JM, McMahon D: Chiari Malformation and Syringomyelia. The Mayfield Clinic Brochure, University of Cincinnati Department of Neurosurgery, 2012, pp 1-12.
  16. Rodgers SJ, Whitehead D: Factsheets for docs-on-the-go: Chiari-1 malformation. 2005. http://www.indabook.org/d/Factsheets-for-Docs-on-the-go-Chiari-1-Malformation.pdf.
  17. Oppenheimer DR: The cervical cord in multiple sclerosis. Neuropathol Appl Neurobiol 1978;4:151-162.
  18. Seaman DR, Winterstein JF: Dysafferentation: a novel term to describe the neuropathological effects of joint complex dysfunction - a look at likely mechanisms of symptom generation. J Manipulative Physiol Ther 1998;21:267-280.
  19. Jackson R: The Cervical Syndrome, ed 4. Springfield, Charles C Thomas, 1977.
  20. Panjabi MM, Cholewicki J, Nibu K, Grauer JN, Babat LB, Dvorak J: Mechanism of whiplash injury. Clin Biomech 1998;13:239-249.
  21. Griffths HJ, Olson PN, Everson LI, Winemiller M: Hyperextension strain or ‘whiplash' injuries to the cervical spine. Skeletal Radiol 1995;24:263-266.
  22. Bogduk N: Anatomy and physiology of headache. Biomed Pharmacother 1995;49:435-445.
  23. Dreyfuss P, Michaelson M, Fletcher D: Atlanto-occipital and lateral atlanto-axial joint pain patterns. Spine 1994;19:1125-1131.
  24. Hack GD, Hallgren RC: Chronic headache relief after section of suboccipital muscle dural connections: a case report. Headache 2004;44:84-89.
  25. Deliganis AV, Baxter AB, Hanson JA, Fisher DJ, Cohen WA, Wilson AJ, Mann FA: Radiologic spectrum of craniocervical distraction injuries. Radiographics 2000;20:S237-S250.
  26. Brohi K: Initial assessment of spinal trauma. 2002. http://www.trauma.org/archive/spine/cspine-eval.html.
  27. Elsig JP, Kaech DL: Dynamic imaging of the spine with an open upright MRI: present and future perspectives of fMRI. Argo Spine News J 2007;16:42-45.
  28. Vitaz TW, Shields CB, Raque GH, Hushek SG, Moser R, Hoerter N, Moriarty TM: Dynamic weight-bearing cervical magnetic resonance imaging: technical review and preliminary results. South Med J 2004;97:456-461.
  29. Moazzaz P, Hong SW, Miyazaki M, Ashkan M, Wang J: Positional MRI: A valuable tool in the assessment of cervical disc bulge: proceedings of the 22nd annual meeting of the North American Spine Society. Spine J 2007;7(suppl):S1-S192.
  30. Giuliano V, Giuliano C, Pinto F, Scaglione M: The use of flexion and extension MR in the evaluation of cervical spine trauma: initial experience in 100 trauma patients compared with 100 normal subjects. Emerg Radiol 2002;9:249-253.
  31. Muhle C, Wiskirchen J, et al: Biomechanical aspects of the subarachnoid space and cervical cord in healthy individuals examined with kinematic magnetic resonance imaging. Spine 1998;23:556-567.
  32. Djordie R, Nenad I, Jovo K, Dragan S, Zelimir A, Slobodan T, Nikola A, Srdjan B, Petar O: Incidence and distribution of extravascular compression of extracranial venous pathway in patients with chronic cerebrospinal venous insufficiency and multiple sclerosis. Phlebology 2013;29:476-479.

Article / Publication Details

First-Page Preview
Abstract of  

Published online: March 27, 2015
Cover Date: 2015

Number of Print Pages: 19
Number of Figures: 17
Number of Tables: 0

ISBN: 978-3-318-02696-2 (Print)
eISBN: 978-3-318-02697-9 (Online)