Fractures of the craniovertebral junction associated with other fractures of the spine: overlooked entity?

In a review of 155 craniovertebral fractures (occiput-C1-C2), 40 of these had associated fractures and/or dislocations or subluxations elsewhere in the spine. This rather common occurrence, one of four, has not been emphasized in the recent literature, indicating that the radiologic examination should not stop after the craniovertebral fracture is identified. Furthermore, in 13 patients, neurologic deficits were encountered that in all instances were from associated lower-level fracture. From this experience it was believed that a minimum of anteroposterior and lateral views of the entire spine should be obtained in patients in whom a craniovertebral fracture is found, especially if neurologic deficits are present. The other sites of injury were in the lower cervical spine in 17 patients, in the thoracic spine in five, in the lumbar spine in two, and in the sacrococcygeal spine in two patients. Eight patients had three or more levels of fracture.