Clinical Cases

Unstable dens fracture

Approximately 40 years ago, this female patient sustained a whiplash-injury in a road accident.

Ever since, she has suffered from migraine-type headaches. In the past 1.5 years, restrictions in movement of the cervical spine have increased and pain occurred at the cranio-cervical junction. In addition, since January, she has experienced tinnitus in her left ear and also noticed a frequent tingling in her left hand.

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A – C: Sagittal image in sitting position: Neutral, flexion, extension
D – E: Coronary Image in sitting position, head neutral 


The Upright™ MRI of the head shows noticeable problems with the dens axis.
Upon examination of the cervical spine, upright in a natural weight-bearing state, a diastasis at the base of the dens is visible.

The Upright™ MRI functional images show an instability of the cranial part of the dens. In flexion, the sagittal image clearly depicts a ventral displacement of the cranial part of the dens. Retrodentally, the sagittal image shows an increase in soft tissue. In addition, in coronary view, marginal bulging at the atlanto-axial joint is visible on the right.

All in all, C1-C2 shows a slight spinal position-related narrowness.


Old unstable dens fracture type II according to Anderson and d’Alonzo, resulting in function-dependent slight stenosis of the spinal canal.

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