PMC7827302_01
Clinical photograph showing right-sided torticollis with features of facial asymmetry including smaller eye size.
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F1
It was associated with facial asymmetry including a smaller right eye [Figure 1].
3D CT scan showing absent C1 spinous process with adjacent lamina (posterior arch deficiency) and complete fusion of posterior elements of C2 and C3.
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F2
The radiographs revealed evidence of fusion between the C2 and C3 vertebral bodies with a dysplastic C1, while the CT scan confirmed an absent C1 spinous process and adjacent lamina (posterior arch deficiency) [Figure 2].
3D CT scan showing occipitalization of the right side of lateral mass of C1, discontinuity in anterior arch of C1, left side lateral mass of C1 with residual anterior arch of C1 showed fusion with body of C2 anteriorly with minimal space between left lateral mass of C1 and C2 in contrast to the right side.
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F3
The CT scan showed additional bony anomalies as explained in [Table 1] and [Figures 3 and 4].
CT scan showing subtraction view showing odontoid nonseparation and its assimilation with anterior arch of atlas.
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F4
The CT scan showed additional bony anomalies as explained in [Table 1] and [Figures 3 and 4].
T2 Sagittal image sequence of MRI showing no evidence of cord compression.
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F5
MRI showed no evidence of cord compression [Figure 5].
Immediate postoperative lateral and anteroposterior X-ray showing C1 C2 fixation by Goel and Harm technique.
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F6
As there was fusion between the C1 and C2 bodies, we passed larger bilateral pedicle screws into the C2 vertebral body [Figure 6].
Schematic representation of intraoperative reduction maneuver.
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F7
Intraoperative reduction/compression was performed on the right side between the C1 and C2 screws to correct the torticollis [Figure 7].
Clinical photograph on postoperative day 2 showing correction of torticollis and maintained in cervicothoracic orthosis.
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F8
Two years later, the patient remains asymptomatic [Figure 8].