PMC9062924_01
Preoperative images showing all aspects of the complex C2 fracture. (a) Midsagittal CT bone window. The white arrow points to the oblique axis body fracture with dislocation. The black arrow shows an anteroinferior C3 body fracture. (b) The right and (c) left parasagittal images. The red arrow points to the right pars interarticularis fracture while the green arrow points to the left C2 superior facet fracture. (d) Midsagittal MRI T2 image shows no compression or cord signal changes. (e) Anterior and (f) right lateral 3D reconstruction shows both aspects of the fracture. (g) White arrow points to the neural ring part of the fracture.
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F1
Additional fractures of the pars interarticularis on the right side and the superior facet on the left side were observed, resulting in bilateral encroachment on the foramina transversaria [Figure 1].
Intraoperative C-arm images (a) in supine position C2 and fracture level are being confirmed. (b and c) A curette is navigated into the fracture in a controlled manner to release adhesions. The black arrow points to the C1 anterior arch, the green arrow points to the posterior vertebral line and posterior aspect of the odontoid while the red arrow shows the additional C3 fracture. (d) In the supine position, bilateral C2 pedicle screws are inserted.
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F2
The surfaces of the body fracture were curetted to prepare for fusion [Figure 2].
Postoperative CT bone window. (a) Axial, (b) midsagittal, and (c) right parasagittal cuts. Black arrows point to the location of fractures.
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F3
C2, a K-wire was drilled into the pedicles across the fracture line and into the mobile fragment on both sides. Cannulated lag screws were passed over the K-wires, which compressed the fractured fragment with bicortical purchase [Figure 3].
X-rays obtained at 2 months follow-up show no change to immediate postoperative images. (a) Lateral view and (b) anteroposterior view. The white arrow points to the oblique body fracture and the red arrow to the neural ring fracture.
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F4
Radiographs confirmed continued stability of the fusion construct [Figure 4].
Images taken at 8 months postoperative (a) midsagittal, (b) right parasagittal, and (c) axial CT bone window cuts. Red arrows indicate the location of healed fractures. (d) Extension and (f) flexion X-rays indicate no instability of the region. The white arrow shows the location of healed C3 fracture.
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F5
By 8 postoperative months, the patient had no residual neurological deficit, full range of motion, and dynamic X-rays and the CT confirmed stability with fusion across all fracture lines [Figure 5].