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Roentgen Diagnosis of the Craniovertebral Region

Oscar Sugar, MD, PhD
JAMA. 1975;232(10):1066-1067. doi:10.1001/jama.1975.03250100058036.
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The lesson to be learned from this detailed atlas is the mutual interdependence of clinician and radiologist. Founder of the Strasbourg school of neuroradiology, Wackenheim had early training in neurology and psychiatry. He emphasizes the possibility of providing reasons for subjective complaints without neurological signs, using plain films, contrast studies, and, above all, tomograms. These last, he says, are too important to be left to the technician but require intimate supervision by the neuroradiologist (who may order views in flexion, extension, and rotation). They permit demonstration of subluxations and ligamentous disorders, often in relationship to the gross appearance of the patient (short neck, hypermobile neck, cranial and facial asymmetry, torticollis). Rheumatology, traumatology, congenital variations, and above all, neurosurgical lesions are the principal reasons for investigation of the area roughly encompassing the region between the axis and the fourth ventricle. Congenital anomalies and normal variations become obviously important in evaluation, and


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