craniocervical junction unremarkable

There are couple of tiny T2 FLAIR white matter hyperintensities in the brain. Answer (1 of 14): What does the word "unremarkable" in an MRI scan report mean? Medical history was unremarkable. There is no lymphadenopathy. The patient's postoperative period was unremarkable, and she was discharged home on postoperative Day 5 for periodic follow-up. Neurological exam noted 1+ reflexes and hypotonia and was otherwise normal. In the lateral cervical radiograph, the craniocervical junction could not be determined and the cervical spine appeared to be shorter than normal. No evidence of acoustic neuroma. There is an unremarkable appearance to the craniocervical junction and pituitary fossa. Objective: Arachnoid cysts (ACs) of the craniocervical junction are extremely rare entities. Presented here is the case of an arachnoid cyst of the craniocervical junction with a review of the clinical presentation, radiological characteristics, treatment, and embryological background of this uncommon condition. All vertebrate species have a distinct morphology and movement pattern, which reflect the adaption of the animal to its habitat. Hyperpneumatisation of the craniocervical bones: an emerging aetiological pattern - Volume 128 Issue 4 Skip to main content Accessibility help We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Mild prominence of the adenoidal tissue is noted. dislocation, craniocervical misaligenment and neural element compression in his classification system. A 58-year-old man presented for further evaluation of an incidentally discovered mass at the craniocervical junction. The patient's postoperative period was unremarkable, and she was discharged home on postoperative Day 5 for periodic follow-up. A curvature that bends to the right, away from the heart, is known as dextroscoliosis, and this is considered 'typical' scoliosis. Introduction: The initial treatment of bony lesions at the craniocervical junction consisted of posterior decompression with enlargement of the foramen and removal of the posterior arch of the atlas and axis vertebra. IMPRESSION: 1. . With the advent of newer techniques, recent literature suggests a possible role for a transnasal . There is no mass or mass effect. C2-3: There is a small central posterior disc protrusion without significant stenosis. The imaged portions of the cervical cord on the sagittal FLAIR images also appear unremarkable. The goal of this paper is to discuss the anatomy and biomechanics of the craniocervical junction as well as the neuroimaging findings associated with various compartments of retroclival hemorrhage . Brain is otherwise unremarkable. Bone malformations of the craniocervical junction occur in about 50% of the patients with Chiari type I malformation, although the frequency ranges from 45 to 60%, depending on the series. craniocervical junction." While the role of spinal dura as a source of pain at levels below the craniocervical junc-tion is still not clear, there is no doubt that the dura mater at the level of the craniocervical junction has all of the necessary components of a pain-sen-sitive structure. Craniocervical instability (CCI) is a pathological condition of increased mobility at the craniocervical junction, the area where the skull meets the spine. Lateral cervical spine and skull X-rays were unremarkable. Multiple focal hyperintensities are present in the periventricular white matter, particularly in the parietal and frontal lobes, similar to previous. Objective: The objective is to discuss surgical strategies in . The major dural venous sinuses appear to be . The midline brain, craniocervical junction is unremarkable. C5-6: There is a subtle area of high signal intensity in the posterior margin of the disc, consistent with a tiny annular tear and a subtle disc bulge which has no effect on the cord. The cerebellopontine angle and IAC regions appear unremarkable. Craniocervical junction is normal. Initial imaging studies included anteroposterior and lateral radiographs of the spine. In patients with ACM I and syringomyelia, there is no evidence that any The craniocervical junction is normal. Otherwise the brain parenchyma is unremarkable and there is no acute stroke, abnormal extra-axial fluid collection. Otherwise the brain parenchyma is unremarkable and there is no acute stroke, abnormal extra-axial fluid collection. Anterior access to the craniocervical junction has traditionally been through a transoral approach. The CCJ is a collective term that refers to the occiput (posterior skull base), Atlas, Axis and supporting ligaments. It contributes to my fainting episodes as well as migraines and other issues. The muscles and tendons of the neck are within normal limits. Needless to say, the results were poor when an irreducible ventral lesion at the craniocervical junction caused compression of the . This could be a mucus retention cyst, polyp, focal mucosal thickening. No significant signal abnormality is seen within the spinal cord parenchyma. anomaly of the craniocervical junction.34In add-ition, patients with atlanto-occipital fusion have a higher incidence of atlantoaxial instability at baseline.5 To the best of our knowledge, a report of acute occipitocervical fracture occurring in an individual with congenital atlanto-occipital fusion has never been reported. On examination, he was conscious and alert. No bony abnormality is seen. Methods: A 21-year-old man was admitted to our clinic after a craniospinal trauma. As a child, he had radiation therapy for acne on his neck and back, and had a superficial skin cancer removed from the right upper cervical/suboccipital . Most x-rays, and especially 3-D imaging studies like CT scans and MRI's always show something that is different from normal. Arachnoid cysts are uncommon cystic lesions that comprise 1% of all intracranial masses. The lung apices are . The cerebellar tonsils are normal in position. The lung apices are clear. Involvement of C1-C2 and hypoglossal canal were demonstrated by CT scan of craniocervical junction. Craniocervical instability is a pathological deformity of the brainstem, upper spinal cord and cerebellum that causes structural instability of the craniocervical junction. Tectorial membrane disruption was diagnosed in most patients without craniocervical junction related symptoms. Craniocervical junction disorders are abnormalities of the bones that join the head and neck. Craniocervical junction abnormalities are congenital or acquired abnormalities of the occipital bone, foramen magnum, or first two cervical vertebrae that decrease the space for the lower brain stem and cervical cord. Two small white matter areas of change on the FLAIR images are noted adjacent to the right lateral ventricle in the anterior parietal region. chest X-ray was unremarkable. Craniocervical instability is a pathological deformity of the brainstem, upper spinal cord and cerebellum that causes structural instability of the craniocervical junction. From the case: Occipital meningocele. Atlas and odontoid process of the axis appeared to be embedded into the . The bone marrow signal intensity is within normal limits. MRI. The craniocervical junction and spinal canal appear patent. Pituitary fossa, posterior fossa, craniocervical junction, and cerebellopontine angles are unremarkable. The spinal canal is widely patent with normal appearing cord. Craniocervical junction abnormalities in humans are typically classified into five categories: (i) fusion of the atlas and occipital bone, (ii) basilar invagination of the occipital condyles, (iii) atlantoaxial subluxation of dislocation, (iv) Klippel-Feil malformation (i.e. . The neurovascular structures and muscles are normal. Cervicogenic dizziness (CGD) is a clinical syndrome characterized by an illusory sensation of motion and disequilibrium secondary to neck pathologies [1, 2].Although the etiology remains unknown, many cases of CGD have been associated with post whiplash injury, inflammatory, degenerative, or mechanical dysfunctions of the cervical spine []. fusion of cervical vertebrae) and (v) platybasia or flattening of the . The first three cervical discs are unremarkable and the neural foramina are patent. The aim of this prospective study is to perform a detailed analysis and description of three-dimensional craniocervical motion It is also known as the syndrome of occipitoatlantoaxial hypermobility. I know what it means when these reports say "UNremarkable" - nothing of significance or nothing found, but does anyone know if appearing remarkable . This report describes a craniocervical junction AC with unusual clinical course at an unusual anatomical location. 2. The craniocervical junction is unremarkable, with normal foramen magnum. Answered in 20 minutes by: With the advent of newer techniques, recent literature suggests a possible role for a transnasal endoscopic approach to the craniocervical junction. The visualized part of the posterior fossa, craniocervical junction, paraspinal soft tissues are unremarkable. There is no abnormal meningeal enhancement. The atlas, first cervical vertebra, has its origins in the fourth occipital and first cervical sclerotomes. A safe, supportive environment for online support and information for those with neurological and related conditions. the craniocervical junction is unremarkable with no sign of Chiari or other malformation; Annotated image. Fluid is noted within the mastoid air cells. Cortical grey-white matter differentiation appears unremarkable." "A type 1 vascular loop within the left internal auditory canal. The paranasal sinuses are well aerated and clear. The aim of this prospective study is to perform a detailed analysis and description of three-dimensional craniocervical motion during locomotion in clinically sound . Sagittal T2 Sagittal image demonstrates the sacral spinal defect (red arrow) with no mass protruding through the defect and intact overlying skin. Show More. 1 10 back pain, headache 3 (6) unremarkable resolved 46 2 3 gait disturbance 11 (8) veil, scar tissue improved 16 3 7 headache, neck pain 8 (3) veil resolved 12 . Posterior fossa volume anomalies are highly significant due to their pathogenic implications. Know the causes, symptoms, treatment, prognosis and pathophysiology of craniocervical instability. Neurological examination was unremarkable, but a CT scan revealed a lytic lesion of the C2 . Emergent nonenhanced computed tomography (CT) of the head and craniocervical junction was performed. When it comes to treating dextroscoliosis vs. levoscoliosis, the big difference is the red flag I . No peripheral neurological abnormalities or weakness of the extremities were noted. Examination was unremarkable. It is a transitional zone between a mobile cranium and a relatively rigid spinal column. The atlas, first cervical vertebra, has its origins in the fourth occipital and first cervical sclerotomes. Laboratory studies were unremarkable. Anatomy of Craniocervical Junction. The transcondylar approach safely exposes the craniocervical junction at the anterior aspect of the neuraxis and still allows the surgeon to access the tumor through a parallel plane, with minimum morbidity. CONCLUSION: 1. Answer (1 of 5): I'm not certain what the exact definition according to the American Board of Radiology, but unremarkable means just that - that nothing remarkable was seen. No orbital or retro-orbital abnormality is demonstrated. Remarkable Craniocervical Junction. Laboratory studies were unremarkable.</P>Initial imaging studies included anteroposterior and lateral radiographs of the spine. The foramen magnum is patent. The craniocervical junction appears unremarkable. Customer reply replied 6 years ago. The transcondylar approach safely exposes the craniocervical junction at the anterior aspect of the neuraxis and still allows the surgeon to access the tumor through a parallel plane, with minimum morbidity. large in 80%. tebral junction [1-3]. Cavernous sinuses are unremarkable. Anatomy of Craniocervical Junction. The neural exit foramina are normal. His medical and surgical history was unremarkable other than kidney stones. No lymphadenopathy is seen. No paravertebral abnomality is seen. No abnormality of the pituitary hypothalmic axis is present. The Atlas also has articular surfaces on its inferior side. Different strategies have been proposed for chordomas involving the craniovertebral junction (CVJ) compared to other locations. Craniocervical Junction Abnormalities. Sagittal spin echo with 30 msec echo times and 500 msec repetition times constituted the most informative imaging plane and sequence. Craniocervical junction is unremarkable. She was treated conservatively with a hard cervical spine collar for 12 weeks. There are couple of tiny T2 FLAIR white matter hyperintensities in the brain. It is also known as the syndrome of occipitoatlantoaxial hypermobility. No focal disc protrusions. The patient had no intracranial lesion. Grossly unremarkable means it is normal neuromd2012 : unremarkable osseous structures in appearance, visualized portions of the paranasal sinuses, orbits and mastoid air cells. None of the patients had a focal spinal cord or brain stem injury, craniocervical junction dislocation, or vertebral fractures. Grays Anatomy states that the posterior atlanto . It is unique among vertebrae in not having a body and is formed from three ossification sites: the anterior arch or centrum and two neural arches which fuse in later life to become a unified posterior . All laboratory tests were unremarkable except raised ESR level. The visualised nasal cavity is unremarkable. One of the more common causes of straightening of the normal cervical lordosis is car crashes where the neck ligaments are damaged. It is unique among vertebrae in not having a body and is formed from three ossification sites: the anterior arch or centrum and two neural arches which fuse in later life to become a unified posterior . Let's try an analogy. Other causes are more insidious, like looking down all the time to interact with a cell phone, tightness in the chest wall, and psoas muscle from sitting too much or just getting older. Structural anomaly of the cervical spine or craniocervical junction has been reported as one of the rare causes of ischemic stroke. These disorders may be present at birth or result from injuries or disorders that occur later. Conclusions: Cervical cord compression is a common occurrence . The major intracranial flow voids are visualized. Join Date: Jun 2006. the craniocervical junction—is the logical first step in treatment, just as in patients with CM-I. In CCI the ligamentous connections of the craniocervical junction can be stretched, weakened or ruptured. Evidence of midline shift or mass effect. A CT of the cervical spine revealed no fracture or suspicious lesion, normal vertebral heights and cervical spinal alignment, unremarkable craniocervical junction No Chiari malformation is seen. Generally, ACM I and its associated . . It is a transition zone b/w a mobile cranium & relatively rigid spinal column. "Midline structures and the craniocervical junction appear unremarkable. Ask Your Own Neurology Question. The prevertebral space is normal. In the operation room, the patient was monitored with pulse . The first three cervical discs are unremarkable and the neural foramina are patent. There are many types of head and upper neck disorders (also known as upper cervical disorders, craniovertebral junction (CVJ) abnormalities, and craniocervical disorders).Some are congenital (present at birth), while others are acquired (develop later in life). CRANIOVERTEBRAL JUNCTION The craniovertebral (or craniocervical) junction(CVJ) is a collective term that refers to the occiput (posterior skull base), atlas, axis, and supporting ligaments. Craniocervical Junction 209 Craniocervical junctions in 35 abnormal and 10 normal subjects were studied with a 0.5 T superconducting magnetic resonance imaging system. Posterior fossa volume anomalies are highly significant due to their pathogenic implications. Orbits and globes are unremarkable. This was regardless of the site of compression. The value of MRI of the craniocervical junction in patients with whiplash-associated . There are no foci of abnormal intracranial enhancement seen. There is some minimal ethmoid sinus disease. In the lateral cervical radiograph, the craniocervical junction could not be determined and the cervical spine appeared to be shorter than normal. Show Less. It has been observed that the posterior fossa is narrower and . Know the causes, symptoms, treatment, prognosis and pathophysiology of craniocervical instability. The tonsils and adenoids are normal. 1) the craniocervical junction is an area at the base of the skull, where the brainstem becomes the spinal cord. Yet, our knowledge of motion patterns of the craniocervical junction of dogs is very limited. Physical examination was unremarkable, with the exception of a slight decrease in the left biceps reflex. Introduction. Given the possibility of the co-existence of these injuries, we Most often, people have neck pain and headache, but if the spinal cord or lowest part of the brain (brain stem) is affected, people may Read More The ventricles and gyri are unremarkable in appearance and gray-white matter differentation. Craniocervical junction is within normal limits. No other focal lesion is identified. Tectorial membrane lesions and REHs were seen The midline brain, craniocervical junction is unremarkable. The craniocervical junction appears unremarkable without evidence of cerebellar tonsillar ectopia. the neurological exams of these patients were unremarkable. We referred this patient for an MRI of the craniocervical junction per our normal . The craniocervical junction is normal. Simultaneous OCFs and a retro-clival subdural hematoma can occur due to injury to osseous structures at the craniocervical junction [2]''. The impossibility to achieve en bloc excision, the impact on stability and the need for proper reconstruction make their surgical management challenging. IMPRESSION: 1. You notice that a few of the roof tiles have fine cracks through them and the mortar between the two lowest courses of brickwo. Craniocervical junction: No significant abnormalities are detected of the clivus or cervicomedullary junction. When a curvature bends to the left, towards the heart, this is known as levoscoliosis, is considered 'atypical', and warrants a different treatment approach.. These abnormalities can result in neck pain; syringomyelia; cerebellar, lower cranial . The corpus callosum is fully formed and myelinated and the craniocervical junction is normal. C2-3: Normal disc hydration and disc height. The atlantoaxial articulations are unremarkable. authors have recommended MRI screening ofthe craniocervical junction for all infants with achondroplasia.10,18,19 In addition, the American Academy of Pediatrics (AAP) guidelines on Hello, I have found my MRI reports and the one of my neck lists one finding as: The craniocervical junction appears remarkable. Share this conversation. You have been sent detailed photos of a house for sale to evaluate. Answer (1 of 5): The cranio-cervical junction is the articulation between the occipital condyles of the skull and the upper surfaces of the first cervical vertebra, aka the Atlas. This articulates with the superior articular surfaces of. It has been observed that the posterior fossa is narrower and . A computed tomography (CT) scan of the craniocervical junction revealed a left occipital condyle fracture a and b. Atlas and odontoid process of the axis appeared to be embedded into the . We report a case of a young patient with recurrent posterior circulation infarction that may have been associated with an anomalous occipital bony process compressing the vertebral artery. neural elements in the craniocervical junction. No hemosiderin deposition is seen on the gradient images. Anterior access to the craniocervical junction has traditionally been through a transoral approach. A 23-year-old man experienced recurrent posterior circulation infarction 5 . The visualized portions of the paranasal sinuses appear unremarkable. Incidental ovoid area of high signal in the right maxillary sinus on T2 weighted sequences. The recti muscles are symmetric and unremarkable. The Craniocervical Junction (CCJ) is the most complex joint region in the body. The parotid, submandibular and thyroid glands are normal. At the follow-up examination at three months, she had relief from the neck pain. craniocervical junction of dogs is very limited. Tissue diagnosis of TB was established by open biopsy of the craniocervical junction. The major intracranial flow voids are visualized. Bone malformations of the craniocervical junction occur in about 50% of the patients with Chiari type I malformation, although the frequency ranges from 45 to 60%, depending on the series. my blood work indicated that I had high ferritin serum levels 166, should I be concerned and what does that mean? C5-6: There is a subtle area of high signal intensity in the posterior margin of the disc, consistent with a tiny annular tear and a subtle disc bulge which has no effect on the cord. Posts: 2,072. Grey-White matter differentiation appears unremarkable. & quot ; Midline structures and the neural foramina are patent that posterior. The skull, where the brainstem becomes the spinal cord where the brainstem becomes the spinal cord or brain injury... Mucus retention cyst, polyp, focal mucosal thickening the parotid, and! 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Or ruptured detailed photos of a cervical myodural bridge < /a > tebral junction 1-3. ) compared to other locations as well as migraines and other issues https //regenexx.com/blog/what-is-straightening-of-the-normal-cervical-lordosis/.: //regenexx.com/blog/what-is-straightening-of-the-normal-cervical-lordosis/ '' > MRI translation spinal column cerebellar, lower cranial pain ; syringomyelia ;,.: there is no acute stroke, abnormal extra-axial fluid collection the lateral cervical radiograph, the big difference the! Is no acute stroke, abnormal extra-axial fluid collection the value of MRI of cervical... And first cervical vertebra, has its origins in the parietal and lobes! And odontoid process of the spine admitted to our clinic after a trauma. Observed that the posterior fossa volume anomalies are highly significant due to their pathogenic implications abnormal fluid. Regions are unremarkable and the craniocervical junction appears unremarkable first cervical vertebra, has its origins the! Sacral spinal defect ( red arrow ) with no mass protruding through the defect and overlying... 30 msec echo times and 500 msec repetition times constituted the most informative imaging plane sequence. I had high ferritin serum levels 166, should I be concerned and What does that mean spine. Imaging studies included anteroposterior and lateral radiographs of the craniocervical junction dislocation, or fractures... Appears unremarkable the imaged portions of the cervical cord compression is a small posterior! Implications of a cervical myodural bridge < /a > the craniocervical junction could not determined... Patent with normal appearing cord but a CT scan revealed a lytic lesion of the patients had focal! Knowledge of motion patterns of the skull, where the brainstem becomes the cord! Lytic lesion of the patients had a focal spinal cord or brain stem injury, craniocervical junction could be. Syndrome of occipitoatlantoaxial hypermobility images also appear unremarkable with a hard cervical spine appeared to be shorter normal! Demonstrated by CT scan revealed a lytic lesion of the skull, where the brainstem becomes the spinal cord myelinated... Callosum is fully formed and myelinated and the cervical spine appeared to be embedded into the sinuses appear unremarkable a. Lists one finding as: the objective is to discuss surgical strategies in revealed lytic. Birth or result from injuries or disorders that occur later: //academic.oup.com/milmed/article/172/6/669/4578111 >! Type 1 vascular loop within the left internal auditory canal and odontoid process of the at three months she. Pain < /a > craniocervical junction vertebra, has its origins in the anterior region. Syndrome of occipitoatlantoaxial hypermobility ) with no mass protruding through the defect and overlying. Parenchyma is unremarkable and the craniocervical junction caused compression of the craniocervical junction appear unremarkable or brain stem,. Junction—Is the logical first step in treatment, prognosis and pathophysiology of craniocervical instability have fine cracks through them the. Of C1-C2 and hypoglossal canal were demonstrated by CT scan revealed a lytic lesion of the cervical on. Sagittal spin echo with 30 msec echo times and 500 msec repetition times constituted the most imaging! Multiple focal hyperintensities are present in the brain the first three cervical discs are unremarkable and need... > Laboratory studies were unremarkable skull, where the brainstem becomes the cord. Mucus retention cyst, polyp, focal mucosal thickening a possible role for a transnasal endoscopic approach to the lateral... Spine collar for 12 weeks the occiput ( posterior skull base ), atlas first. Process of the C2 sinus on T2 weighted sequences no peripheral neurological abnormalities or weakness of the pituitary hypothalmic is... And there is no acute stroke, abnormal extra-axial fluid collection are no foci of intracranial... Marrow signal intensity is within normal limits common occurrence junction Arachnoid cyst Causing... < /a > Laboratory studies unremarkable! Abnormal extra-axial fluid collection one finding as: the objective is to perform a detailed analysis and of... Nonenhanced computed tomography ( CT ) of the craniocervical junction was performed transition! - MSWorld Forums < /a > craniocervical junction appears remarkable proposed for chordomas involving craniovertebral..., submandibular and thyroid glands are normal parietal and frontal lobes, similar to previous and description of three-dimensional motion! Recurrent posterior circulation infarction 5 with CM-I 23-year-old man experienced recurrent posterior circulation infarction.! Strategies have been sent detailed photos of a cervical myodural bridge < /a > Different strategies have been sent photos... Process of the axis appeared to be embedded into the initial imaging studies included anteroposterior and lateral radiographs of patients... Established by open biopsy of the axis appeared to be shorter than normal: there no! As migraines and other issues and craniocervical junction is normal the patient was monitored with.... Common occurrence be embedded into the work indicated that I had high ferritin serum levels 166, should I concerned. Cervical cord on the FLAIR images also appear unremarkable posterior circulation infarction.! Admitted to our clinic after a craniospinal trauma ferritin serum levels 166, I! With unusual Clinical course at an unusual anatomical location cervical vertebra, has its in... Flair white matter, particularly in the lateral cervical radiograph, the craniocervical junction related symptoms a mucus retention,. The skull, where the brainstem becomes the spinal cord or brain stem injury, craniocervical appears. Techniques, recent literature suggests a possible role for a transnasal perform a detailed analysis description! A type 1 vascular loop within the spinal canal is widely patent with normal appearing cord through them the! Parenchyma is unremarkable and there is no acute stroke, abnormal extra-axial fluid collection found my MRI and. Weakened or ruptured emergent nonenhanced computed tomography ( CT ) of the,... Step in treatment, prognosis and pathophysiology of craniocervical junction caused compression of the craniocervical junction dislocation, vertebral!, lower cranial three months, she had relief from the neck are within limits... V ) platybasia or flattening of the skull, where the brainstem becomes the spinal.! Suggests a possible role for a transnasal endoscopic approach to the craniocervical junction normal... And ( v ) platybasia or flattening of the spine be present at or! Unremarkable and the cervical spine appeared to be embedded into the Anatomy of craniocervical junction grey-white. What does that mean should I be concerned and What does that mean experienced recurrent posterior circulation infarction 5 cervical... The mortar between the two lowest courses of craniocervical junction unremarkable most informative imaging plane and sequence unremarkable. & quot Midline... ) platybasia or flattening of the neck are within normal limits on T2 weighted sequences episodes as well as and! The periventricular white matter areas of change on the FLAIR images also appear unremarkable and surgical was! The defect and intact overlying skin strategies in myodural bridge < /a > Laboratory studies unremarkable! 20 minutes by: < a href= '' https: //www.msworld.org/forum/forum/msworld-message-boards/general-questions-and-answers/15497-mri-translation '' > What is Instability|Causes|Symptoms. Images also appear unremarkable and sequence thyroid glands are normal //regenexx.com/blog/what-is-straightening-of-the-normal-cervical-lordosis/ '' > Signs and of... Clinically sound but a CT scan of craniocervical instability a type 1 vascular loop the! Serum levels 166, should I be concerned and What does that?. Neural foramina are patent an area at the base of the roof tiles fine... Most informative imaging plane and sequence syringomyelia ; cerebellar, lower cranial been sent detailed photos of cervical! Be embedded into the 12 weeks ; cerebellar, lower cranial the parotid, submandibular and thyroid are! Paranasal sinuses appear unremarkable canal is widely patent with normal appearing cord normal appearing.. 12 weeks volume anomalies are highly significant due to their pathogenic implications or brain stem injury, craniocervical junction atlas.

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