In Vivo Ultrasound Imaging of the Spinal Cord and Subarachnoid Space at the C1-C2 Level in Healthy Adult Subjects

Ultrasound (US) imaging of the spinal canal is applied in early infants before formation of posterior spine bony elements. Here, we demonstrate for the first time in adult healthy subjects that excellent visualization of intrathecal structures at the level of C1-C2 is possible by transcutaneous US in flexion, extension, and neutral head positions through the soft tissue US window between C1-C2. We show with US that the posterior subarachnoid space increases significantly in head extension. Accordingly, C1-C2 US guidance can facilitate cervical myelography. In addition, we suggest that US of the C1-C2 spine level may offer an adjunct tool to diagnosing structural abnormalities in the setting of traumatic, congenital, or degenerative pathologies of the craniocervical junction.