PMC7771482_01
Lateral cervical radiograph showing C1 foramen transversarium indicating possible rotation of atlas (while arrow).
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F1
The lateral cervical plain radiographs and computed tomography (CT) axial, 2D, and 3D reconstructed images showed C1-C2 AARF with destruction of the left lateral mass of the atlas [Figures 1-4].
Axial computed tomography scan showing destruction of the left C1 lateral mass, note approximation of the odontoid to the left lateral mass.
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F2
The lateral cervical plain radiographs and computed tomography (CT) axial, 2D, and 3D reconstructed images showed C1-C2 AARF with destruction of the left lateral mass of the atlas [Figures 1-4].
Reconstructed computed tomography scan (a) coronal, (b) sagittal showing destruction of the left lateral mass of atlas.
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F3
The lateral cervical plain radiographs and computed tomography (CT) axial, 2D, and 3D reconstructed images showed C1-C2 AARF with destruction of the left lateral mass of the atlas [Figures 1-4].
3D computed tomography scan of the atlantoaxial complex (a) frontal view showing destruction of the left lateral mass and a part of anterior ring of atlas, note forward displacement of the right C1 lateral mass. (b) Occipital view demonstrates rotation of the posterior ring of atlas to the right.
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F4
The lateral cervical plain radiographs and computed tomography (CT) axial, 2D, and 3D reconstructed images showed C1-C2 AARF with destruction of the left lateral mass of the atlas [Figures 1-4].
Reconstructed coronal computed tomography angiography shows integrity of the left V3 segment of the vertebral artery passing through the destructed lateral mass.
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F5
The integrity of the vertebral artery at C1-C2 was also critically confirmed on the preoperative CT angiogram (CTA) [Figure 5].
Intraoperative photograph, (a) the lesion of the left lateral mass of atlas. (b) The site after removal of the mass. (c) The lateral mass is reconstructed with tricortical iliac autogenous bone graft, note C2 pedicle and C1 hook. (d) After assembling the rod.
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F6
Surgery required; the initial insertion of bilateral C2 pedicle screws, isolation of the V3 segment of the vertebral artery, removal of the destroyed left C1 lateral mass in a piecemeal fashion, and fusion (e.g., utilizing a tricortical iliac bone graft secured with left C1 laminar hook-C2 pedicle screw, and an additional right C1 lateral mass-C2 pedicle screw rod construct) [Figure 6].
Postoperative X-ray. (a) A week after surgery showing the C2 pedicle-C1 lateral mass and hook construct used properly. (b) At 1-year follow-up.
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X-rays taken 1 week, and 3 months after surgery demonstrated adequate alignment of the instrumentation/ construct [Figure 7].
Photograph of the patient, a year after surgery while holding up her cervical radiographs.
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F8
Three years later, the patient is asymptomatic [Figure 8].