PMC10228685_01
Preoperative CT scan (bone window) of craniocervical junction. (A) Sagittal CT revealed a dislocated odontoid type II-C fracture (red arrow) and an intradiploic arachnoid cyst in posterior wall of the posterior fossa (blue circle). (B) Coronal CT revealed no lateral dislocation of the fracture of the odontoid process (red arrow). (C) Axial CT scan revealed an unstable Jefferson's fracture (with fracture of the anterior arch on the right, dual fractures of the posterior arch and fracture of the left lateral mass of C1) (yellow arrows).
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F1
A computed tomography (CT) scan of the cervical spine revealed a displaced odontoid type II-C fracture and an unstable Gehweiler type III injury (Jefferson's fracture) with a fracture of the anterior arch on the right, dual fractures of the posterior arch, and a fracture of the left lateral mass of C1 (Figure 1). A coincident finding was an intradiploic arachnoid cyst in the posterior wall of the posterior fossa (Figure 1). Occipitocervical fusion was discussed, but not possible, due to the suboccipital intradiploic arachnoid cyst causing a cerebrospinal fluid (CSF) leak after exposure to the skull during surgery (Figure 1).
CT angiography of the brain-supplying vessels showing no vascular injury. (A) Axial CT scan revealed regular enhancement of internal carotid arteries and V3 segment of vertebral arteries. (B) Coronal CT scan revealed hypoplastic intradural segment of right vertebral artery.
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F2
CT angiography of cervical spine revealed no vascular injury and regular V3 segment of vertebral arteries (Figure 2).
Follow-up sagittal (A,B), coronal (C) and axial (D-F) CT scan revealed proper intraosseous positioning of the screws, furthermore sufficient decompression of atlantoaxial region (A) and beginning fusion the odontoid process (C) and the anterior arch of C1 (D,E).
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F3
Three months' follow-up CT scan confirmed beginning fusion of the fractures (fusion of anterior arch of C1 and beginning fusion of odontoid process (Figure 3).