Occipitocervical Junction (Craniovertebral)

articulatio craniovertebralis

The craniovertebral junction encompasses the atlanto-occipital joints (skull on C1) and the atlantoaxial joints (C1 on C2). This highly mobile two-level complex is uniquely vulnerable — the relatively large head mass combined with the greatest mobility of any spinal region makes this junction the site of life-threatening instability in trauma (atlanto-occipital dislocation), congenital abnormalities (os odontoideum), and inflammatory conditions (Down syndrome, rheumatoid arthritis).

Region: Neck

Clinical Relevance

Clinical Notes

Atlanto-occipital dissociation from high-energy trauma produces distraction injury at the craniovertebral junction — historically fatal but now increasingly survived with aggressive resuscitation and early occipital-C2 fusion. The Power ratio and Harris measurements on lateral cervical radiograph quantify translation. Occipitocervical instrumented fusion with intraoperative neuromonitoring is required.

Pathology

Common Injuries & Conditions

Atlanto-Occipital Dissociation

Ligamentous disruption at the craniovertebral junction from high-energy trauma managed with urgent occipitocervical fusion.