Cervicocranial weight bearing imaging studies to rule out CCI are among the most technically demanding. Cervicocranial Major Stabilizing ligaments- transverse, Alar, Accessory Ligaments- are responsible for Cervicocranial stability, and when they are damaged, as for example due to whiplash, the ligaments elongate, or rupture and once that happens, CCI ensues with many different symptoms.
To assess for CCI it is required to following:
the pure orthogonal alignment and
Cervicocranium, while positioned in weight bearing, must be without any rotation in the Atlantoaxial joint (Cervicocranial Junction, CCJ).
The Atlanto-Axial Joint is a pure rotational joint having 70 percent of all neck rotation happening in that joint. Any rotation in this joint during the weight bearing imaging study will end up in a false positive diagnostic imaging result.
False positive diagnostic studies receive improper treatment protocols, which are unnecessary, expensive and even harmful for the patient.
In addition, 15-degree Cephalad tilt to capture anatomy is required, adding more difficulty since the centers of the X-ray and the centers of the Smartray® GLX 0.1 camera device do not meet due to different angles, capturing the patient’s face becomes harder requiring additional work and time with the adjustments to comply with the requirement.
These studies are among the most technically demanding imaging procedures in the human body, requiring strict adherence to multiple positioning and alignment requirements. Evaluation of the Craniocervical junction under physiologic weight-bearing conditions is best achieved using stationary X-ray imaging coupled with the Smartray® GLX 0.1 positioning system, as even minor patient motion during CT or MRI acquisition can result in non-diagnostic images.
Coupling of Smartray® GLX 0.1 with a stationary X-ray imaging modality is the interrater reliable method of choice to study presence or absence of CCI due to Major Stabilizing Ligaments damages. All other existing diagnostic imaging modalities are less sensitive, have interrater reliability issues (MRI, CT, or X-ray without positioning controls).
