PMC6304856_01
Cervical spine CT scan showing type III left occipital condyle fracture (1), asymmetric left odontoid-lateral mass widening (2), lateral subluxation of bilateral C1 lateral masses (3), and widening of the right atlantooccipital joint (4).
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Anderson and Montesano classification (20) type III left occipital condyle fracture (Figure 1), a Levine and Edwards classification (21) type III (Jefferson) fracture with mild lateral subluxation of bilateral C1 masses (Figure 2), and an asymmetric widening and slight anterior subluxation of the right AOJ (Figure 3). A head CT was performed which showed no acute intracranial abnormalities.
Cervical spine CT scan showing type III Jefferson fracture with anterior arch fracture (1) and posterior arch fractures (2). Note the widening of the atlantodens interval (3).
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Anderson and Montesano classification (20) type III left occipital condyle fracture (Figure 1), a Levine and Edwards classification (21) type III (Jefferson) fracture with mild lateral subluxation of bilateral C1 masses (Figure 2), and an asymmetric widening and slight anterior subluxation of the right AOJ (Figure 3). A head CT was performed which showed no acute intracranial abnormalities.
Cervical spine CT scan. (a) Widening and slight anterior subluxation of the right atlantooccipital joint (1) with preserved anatomy of C1-C2 lateral mass joint (2). (b) Slight anterior subluxation of the left atlantooccipital joint (1) and widening of C1-C2 lateral mass joint (2).
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Anderson and Montesano classification (20) type III left occipital condyle fracture (Figure 1), a Levine and Edwards classification (21) type III (Jefferson) fracture with mild lateral subluxation of bilateral C1 masses (Figure 2), and an asymmetric widening and slight anterior subluxation of the right AOJ (Figure 3). A head CT was performed which showed no acute intracranial abnormalities.
Cervical MRI axial view showing complete disruption of the left transverse ligament (1).
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MRI of the cervical spine was performed and showed ligamentous injury at the craniocervical junction (CCJ) (Figures 4 and 5), asymmetric left odontoid-lateral mass widening, widening and subluxation of the right AOJ (Figure 6), and edema of the paravertebral soft tissues around the fracture.
Cervical MRI sagittal view showing the tectorial membrane displaced off the dens (1) and a focal disruption of the left aspect (arrow). Note the prevertebral edema.
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MRI of the cervical spine was performed and showed ligamentous injury at the craniocervical junction (CCJ) (Figures 4 and 5), asymmetric left odontoid-lateral mass widening, widening and subluxation of the right AOJ (Figure 6), and edema of the paravertebral soft tissues around the fracture.
Cervical MRI coronal view. Dens (1), right occipital condyle (2), right C1 lateral mass (3), left occipital condyle, left C1 lateral mass. Note the bilateral edema in the right atlantooccipital joints (A) and the edema in the C1-C2 reflect mild capsular disruption.
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MRI of the cervical spine was performed and showed ligamentous injury at the craniocervical junction (CCJ) (Figures 4 and 5), asymmetric left odontoid-lateral mass widening, widening and subluxation of the right AOJ (Figure 6), and edema of the paravertebral soft tissues around the fracture.
Postoperative lateral radiograph: occiput-C2 fixation with bilateral C2 pars screws and occiput plate connected with precontoured occiput cervical rods. Past surgical history of C5-C7 anterior arthrodesis.
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Due to the unstable nature of the fracture, the patient was taken to the operating room for emergent occiput-C2 posterior instrumentation and fusion (Figure 7).