“V” shaped predens space

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Abstract
“V” shaped widening of the predens space (PDS) in flexion can be a worrisome finding in trauma patients, possibly representing injury to the transverse ligament. These patients may also show widening of the C-1/C-2 interspinous distance. We think this appearance is usually due to increased flexion mobility at the atlantoaxial level with developmental elongation or laxity of the cranial end of the transverse ligament and/or the posterior ligamentous complex. Tearing of only the cranial end of the transverse ligament must be extremely rare, if it occurs at all; there is no reported proven case. Tearing of only posterior ligaments seems possible and should be evaluated clinically.