PMC5437796_01
(a) Midsagittal computed tomography showing atlantoaxial dislocation with assimilated atlas and C4-C6 fusion (arrow). (b) Coronal computed tomography showing central atlantoaxial dislocation with oblique C1-C2 angles. C3 butterfly is evident (arrow). (c) Parasagittal computed tomography showing oblique C1-C2 joint (arrow). (d) Posterior view of three-dimensional computed tomography showing absent posterior arch and bilateral anomalous vertebral arteries (arrows). (e) Lateral view of three-dimensional computed tomography showing absent C2 posterior arch, C3 posterior elements attached only to C4 but not to C3 body. (f) Axial image showing split body and separated posterior arch
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F1
C1-C2 joints were oblique [Figure 1]. CT angiography revealed anomalous course of vertebral artery.
(a) Postoperative midsagittal computed tomography showing adequate reduction. (b) Coronal computed tomography showing correction of vertical dislocation with C1-C2 joints drilled flat with spacers along with screws in C2 body and C1 lateral masses. (c) Parasagittal showing the spacers and screws. (d) Posterior view of reconstructed computed tomography showing bone grafts form occiput to C4
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F2
Immediate postoperative scan revealed good reduction of the dislocation and was discharged after a week [Figure 2].
X-ray in the 2nd postoperative week showing right lower lobe pneumonia
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F3
Although his improved neurological status was maintained, the chest X-ray showed right lower lung showing pneumatic patch [Figure 3].