PMC3506899_01
Computed tomography scans showing an atlanto-dental interval greater than 5 mm (a), 45 degrees of rotation (b), and asymmetry of the lateral masses of C1 (c).
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At this time, a computed tomography (CT) of the cervical spine with a bone window was performed showing an atlanto-dental interval (ADI) greater than 5 mm (Figure 1(a)), 45 degrees of axial rotation (Figure 1(b)), and no bone fracture. Additionally, an asymmetry of the lateral masses of C1 with respect to the odontoid process was seen on the anteroposterior CT bone scan image and a loss of normal articular apposition at C1-C2 was documented (Figure 1(c)).
Cervical magnetic resonance imaging showing injury of ligament: midsagittal (a), axial (b), and coronal (c) view.
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At this time, a new cervical spine magnetic resonance imaging was performed to determine the disruption of ligaments revealing soft tissues swelling, a Type IA injury of transverse ligament, a complete rupture of the right alar ligament, and a partial injury of the left one (Figures 2(a), 2(b), and 2(c)).
Immediate postoperative radiographs showing the occipitocervical fusion.
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Immediate postoperative radiographs showed a proper implant placement (Figure 3).
Computed tomography scan showing an occipito-cervical stable fusion at the 3-year followup.
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CT bone scans at 60-day and 3-year followup demonstrated an occipitocervical stable fusion (Figure 4); furthermore, the patient was free of pain and torticollis and returned to his normal daily activities.