PMC5758859_01
Patient showing torticollis before treatment, with head tilting, neck rotation, and a characteristic "cock-robin" position (a). Simple cervical open mouth view radiograph showed lateral tilting of the cervical spine and rotated atlas on the axis (b). Coronal (c), axial (d), and 3D (e). CT images showed lateral tilting of C1 and anterior rotated atlas on the axis. Plain radiograph after closed reduction under general anesthesia (e, f).
CRIOR2017-1017307.001.jpg
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fig1
Although we did not notice initially, retrospectively, osteolysis of the odontoid process was shown in the preoperative CT scan (Figure 1).
PMC5758859_02
Patient showing torticollis before treatment, with head tilting, neck rotation, and a characteristic "cock-robin" position (a). Simple cervical open mouth view radiograph showed lateral tilting of the cervical spine and rotated atlas on the axis (b). Coronal (c), axial (d), and 3D (e). CT images showed lateral tilting of C1 and anterior rotated atlas on the axis. Plain radiograph after closed reduction under general anesthesia (e, f).
CRIOR2017-1017307.001.jpg
PMC5758859_02_CRIOR2017-1017307.001.jpg
fig1
Although we did not notice initially, retrospectively, osteolysis of the odontoid process was shown in the preoperative CT scan (Figure 1).
Result of C1-C2 Magerl surgery without a bone graft (a, b). Odontoid process shows osteolysis after C1-C2 Magerl surgery (c). Type 2 AARF recurred 2 weeks after the screw removal. The reconstruction CT shows osteolysis of the odontoid process (d). Preoperative 3D CT showed hypervascularity posterior to C1 (e).
CRIOR2017-1017307.002.jpg
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fig2
We performed C1-C2 Magerl surgery without bone fusion as a temporary fixation (Figures 2 and 2) because the patient was 6 years old and we expected C1-C2 motion preservation after the removal of the screws. We chose the Magerl technique instead of C1 lateral mass screw-C2 pedicle screw and rod fixation because there was abnormal hypervascularity posterior to C1 on preoperative 3D CT angiogram (Figure 2). A plain radiograph and CT image after the surgery showed improvement of AARF, but the odontoid process appeared osteolytic (Figure 2). Reconstructed CT images showed osteolysis of the odontoid process (Figure 2).
Result of posterior fixation surgery using the Magerl-Brooks method with an iliac bone graft.
CRIOR2017-1017307.003.jpg
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fig3
We performed posterior fixation surgery using the Magerl-Brooks method with an iliac bone graft 5 weeks after the recurrence (Figure 3).