PMC4743261_01
A 68-year-old female with remote odontoid fracture presents 25 years later with acutely progressive myelopathy. Computed tomography (sagittal, a) demonstrates a chronic odontoid pseudoarthrosis with anterior subluxation, significant osteophyte (arrow), and segmental kyphosis. Axial section (b) demonstrates the severity of canal compromise arising from the combination of deformity and heterotopic osseous formation
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F1
Computed tomography (CT) [Figure 1], demonstrates a chronic odontoid pseudoarthrosis with anterior subluxation, a significant posterior osteophyte narrowing the spinal canal (arrow), and significant segmental kyphosis overlying the pseudoarthrosis.
Magnetic resonance imaging (sagittal) showed ventral spinal cord compression (arrow) by the posterior osteophyte and the remainder of the C2 body as well as subaxial spinal spondylotic disease
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F2
Magnetic resonance imaging [Figure 2] reveals spinal cord compression ventrally with tension over the posterior osteophyte and the remainder of the C2 body.
Preoperative awake halo traction provided for improved cervical spine alignment by reducing the segmental kyphosis
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F3
At surgery, following awake preoperative halo traction revealing the deformity to be mobile, permitting kyphosis reduction [Figure 3], the patient was in the supine position without further attempt to reduce the ventral translation.
Postoperative X-ray (a) reveals excellent cervical spine alignment following occipitothoracic fusion. Median sagittal computed tomography (b) reveals complete decompression of the odontoid fragment, posterior osteophyte, and residual body
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F4
At 4 months follow-up, she neurologically improved to functional independence (mJOA 17), with no evidence of pseudoarthrosis or implant failure on CT scan [Figure 4].