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The female patient sustained a whiplash injury approximately 40 years ago as the result of a traffic accident.  Since then she has had migraine-type headaches. In the past 1,5 years there have been restrictions in movement of the cervical spine and pain at the craniocervical junction.

Furthermore since January this year she has had tinnitus in the left ear and also a frequent tingling in the left hand.

Functional Imaging in the natural weight-bearing state
Sagittal images, sitting: Neutral, Flexion, Hyperextension

By means of functional imaging in the FONAR Upright™ MRI in the natural weight-bearing state, a clear instability could be proven with maximum displacement of the cranial part of the dens in the flexion position.

The findings :
The Upright™ MRI of the head shows noticeable problems with the dens axis.
During the examination of the cervical spine upright in a natural weight-bearing state a schistasis within the dens is visible. The Upright™ MRI  functional images also show an instabilityof the cranial part of the dens. The sagittal image in flexion shows clearly a ventral displacement of the cranial part of the dens. Retrodental in the sagittal image there is an increase in soft tissue to be seen and in addition, exhibited in the coronar view is a marginal bulge at the atlanto-axial joint on the right with displacement of the spinal cord.

Furthermore a spinal stenosis appears at the level C1/2 slightly depending on the position. 

The diagnosis:
Os odontoideum, dd: old fracture. The pathological restrictions in movement and a small additional ventral situated skeletal element speak rather for an old dens fracture.  There is also a clear instability with spinal stenosis.

Coronar images, sitting, neutral position

Clear schistiasis with a slight tilting of the dens (l).
Visible marginal bulging on the right with a displacement of the spinal cord (r).

This case history was kindly placed at our disposal by Prof. Dr. med. Hans-Konrad Beyer of the Private Practice for Upright™ Magnetic Resonance Imaging Cologne/Germany.
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