PMC6339448_01
Computed tomography scan showing a sagittal cut of the cervical spine with an increased atlantodens interval (6 mm).
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A computed tomography (CT) scan of the cervical spine was conducted to rule out a fracture which was preliminarily reported to have widening of the atlantodens interval (ADI) measuring approximately 6 mm (normal less than 3 mm) (Figure 1).
Computed tomography scan showing sagittal cuts of the cervical spine with significant rotation of C1 on C2 with almost complete loss of articular contact involving the right side.. Abbreviations: R, right; L, left.
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The following morning, the CT scan was reviewed by the radiologist attending who found significant rotation of C1 on C2 with almost complete loss of articular contact involving the right side (Figure 2).
(A) Computed tomography scan of the upper cervical spine showing an axial cut which demonstrates a type II atlanto-axial rotatory subluxation which is consistent with the patient's neck position (rotation to the contralateral side). (B) Coronal cut showing gapping on the left C1-C2 articulation and compression on the right side, which is consistent with the patient's neck position (ipsilateral head tilt).
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II AARS as per the Fielding and Hawking classification requiring prompt spine consultation. In addition to this, there was gapping on the left C1-C2 articulation and compression on the right side (Figure 3).
Lateral cervical spine standing X-ray after 3 weeks of non-operative management showing persistent increased atlanto-dens interval.
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Follow-up standing X-ray showed persistent subluxation of C1-C2 with an increased ADI (Figure 4).
Anteroposterior (A) and lateral (B) views of the cervical spine showing posterior C1-C2 instrumentation with restored normal atlanto-dens interval.
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The patient opted for operative management and underwent C1-C2 stabilization with an open reduction and internal fixation (Figure 5).