PMC9805632_01
Case 1: X-ray of the neck demonstrating cock-robin position (a); T1 magnetic resonance imaging (MRI) of suboptimal quality due to neck tilt (b); lateral X-ray of the craniocervical junction showing increased atlanto-dental interval marked by the red arrow (c); post traction imaging demonstrating complete reduction on lateral X-ray (d) with extensive inflammation seen on axial (e) and sagittal (f) T1 MRI and coronal computed tomography (g) of the cervical spine; postoperative lateral neck X-ray (h); and sagittal T2 MRI (i) demonstrating proper instrumentation and alignment. Yellow dashed line indicates anterior alignment of the cervical spine.
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F2
A 66-year-old female presented with 2 months of dysphagia, neck pain, dysarthric speech, and severe torticollis with the classic "cock-robin" position for several weeks' duration [Figure 2a]. However, when magnetic resonance imaging (MRI) and X-rays showed severe C1/C2 cord compression with anterolisthesis, infectious AARS was diagnosed [Figures 2b and c]. She was reduced by sequential traction (up to 10 lbs) followed by halo application 5 days later [Figure 2d]. Repeat MRI and contrast-computed tomography (CT) confirmed infectious AARS and led to an occiput-C5 posterior spinal fusion with a C1 laminectomy [Figures 2e-h]. The 3-month postoperative MRI demonstrated stable reduction of the C1-C2 subluxation with adequate cord decompression [Figure 2i].
PMC9805632_02
Case 2: X-ray of the neck showing cock-robin position (a); computed tomography (CT) of the cervical spine demonstrating anterior C1 subluxation with destruction of the odontoid process (sagittal, b) and facet joint (coronal, c) with rotation seen in the axial plane (d); sagittal T2 magnetic resonance imaging demonstrating inflammatory process involving C1-2 with cord signal change (e); lateral neck X-ray with increased atlanto-dental interval marked by the red arrow (f); post-traction CT showing restoration of alignment at midline (g) and facet joint (h); and postoperative lateral X-ray with proper instrumentation (i). Yellow dashed line indicates anterior alignment of the cervical spine.
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F3
On examination, his neck was locked in the "cock-robin" position [Figure 3a]. His WBC was elevated at 22,000/mm3, and the cervical CT showed AARS with destruction of the dens and bilateral facet joints [Figures 3b-d]. Figures 3e-f]. Following the application of 15-lbs cervical traction, his motor exam improved to 4/5 in the upper and 5/5 in the lower extremities; traction was then converted to a halo device. The cervical CT confirmed improved alignment with reduction of AARS and resolution of cord compression [Figures 3g-h]. He subsequently underwent a posterior occiput-C5 fusion and was braced in a rigid collar [Figure 3i].