PMC3205484_01
Computed tomography scans of the upper cervical spine obtained 7 months after the initial operation revealing left C1 anterior arch fracture. (a) Three-dimensional computed tomography scan clearly demonstrating the anterior atlas fracture (arrows), and (b, c) consecutive axial computed tomography scans of the C1 showing that the translation is about 5 mm
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F1
Computed tomography (CT) of the upper cervical spine revealed left C1 anterior arch fracture [Figure 1].
Lateral cervical radiographs (a: flexion, b: extension) showing slight instability at C1-C2. The atlanto-dental interval is 3 mm at flexion and reduced at extension
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F2
C1-C2 level [Figure 2]. C1-C2 posterior fusion was carried out in March 2010.
Final operative view of the C1-C2 posterior fusion. Bilateral C1 lateral mass screws and C2 crossing laminar screws are connected to rods with lateral offset. Beta-tricalcium phosphate granules (arrowheads) combined with local bone chips are placed between the lateral masses of C1 and C2
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F3
Beta-tricalcium phosphate granules mixed with local bone chips were placed between the lateral masses of C1 and C2 for better bony fusion [Figure 3].
Postoperative cervical radiographs (a: antero-posterior view, b: lateral neutral view) showing adequate placement of the implants with good cervical alignment. (c) Three-dimensional computed tomography scan showing the overview of the implants. Axial computed tomography scans at (d) C1 and (e) C2 demonstrating appropriately inserted C1 lateral mass screws and C2 laminar screws
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F4
Postoperative studies showed adequate placement of the implants with good cervical alignment and stability Figure 4.