PMC7265439_01
Lateral cervical radiographs, (a) lateral showing 87  subaxial kyphosis, (b) in flexion, kyphosis is aggravated with flexion, note atlantoaxial dislocation, (c) in extension, shows that the kyphosis is fixed.
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F1
Cervical X-rays, MR, and CT studies demonstrated OO instability with subaxial C4-C6 cord compression; there was an accompanying 87  fixed kyphosis [Figures 1-3].
Magnetic resonance imaging (a) demonstrates cervical myelopathy and posteriorly displaced os odontoideum (b) note two myelopathy patches one at upper and one at mid-cervical region.
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F2
Cervical X-rays, MR, and CT studies demonstrated OO instability with subaxial C4-C6 cord compression; there was an accompanying 87  fixed kyphosis [Figures 1-3].
Computerized tomography scan sagittal reconstructed shows a posteriorly displaced os odontoideum.
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F3
Cervical X-rays, MR, and CT studies demonstrated OO instability with subaxial C4-C6 cord compression; there was an accompanying 87  fixed kyphosis [Figures 1-3].
Intraoperative fluoroscopy shows inserting pedicle screws before posterior osteotomy.
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F4
The patient underwent a C2 to C7 laminectomy with C1 lateral mass screw placements and insertion of bilateral pedicle screws from C2 to C7 bilaterally [Figure 4].
Smith-Peterson osteotomy from C2 to C7 along with pedicle screws, note at corpectomy site, short screws is used, note anterior osteotomy at corpectomy levels.
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F5
After assembling a rod on one side from C2 to C7, multilevel Smith-Peterson osteotomies (SPOs) were performed on the contralateral side and vice versa [Figures 5 and 6].
Intraoperative fluoroscopy after assembling the rods, note an acceptable lordosis could be obtained.
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F6
After assembling a rod on one side from C2 to C7, multilevel Smith-Peterson osteotomies (SPOs) were performed on the contralateral side and vice versa [Figures 5 and 6].
Cervical X-ray (a) lateral cross table. A week after surgery, lordosis is 13 , this means that 100  correction. (b) Lateral in sitting position.
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F7
The intraoperative cervical cross-table X-ray ultimately confirmed adequate C1 to C7 instrumentation with a 100  correction of the kyphosis [Figure 7a]. Three months later, the patient was able to eat and button his shirt without difficulty and ambulated with a walker (mJOA score: 11) [Figure 7b].
Plain cervical X-ray at 1-year FU (a) AP and (b) lateral X-ray at 1-year follow-up.
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F8
At 1 postoperative year, he demonstrated no further recovery, and the cervical X-ray showed no further changes in sagittal alignment [Figure 8].