PMC9062932_01
(a-f) Preoperative C-Spine CT scan, bone window. (a) Medial sagittal view, (b) Left paramedian sagittal view, (c) Right paramedian sagittal view, (d) axial odontoid base view, (e) coronal odontoid view, (f) coronal C1-C2 facets view, (g) preoperative cervical MRI T2WI sagittal view, (h) pre-operative cervical MRI T1WI sagittal view.
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F1
MR and CT studies confirmed the continued presence of a type II odontoid fracture with extreme anterior-inferior/rotatory subluxation, and pseudoarthrosis of C0/C1 over the C2 vertebral body, with the residual C1 posterior arch contributing to spinal cord compression. Myelomalacia was also seen on the MR, while the CT documented partial bony bridging between the C1-C2 levels (i.e., especially between the articular facets of the C1 and C2 bodies) [Figure 1].
Patient's C-Spine 3D model. (a) Anterior view, the green line highlights the area to perform surgical bone disarticulation. (b) Posterior view, black dotted line represents the previously surgically removed C1 posterior arch. (c) Right lateral view, black arrow represents the subluxation vector of C1 over C2. Bird's eye view, black arrows represent the C1 and odontoid tip subluxation over the C2 body.
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F2
A 3D CT model of the patients' occipito-cervical junction pathology was obtained to facilitate surgical planning [Figure 2].
(a) Intra-operative imaging of the construct obtained. (b and c) CT scan 3D reconstructions of the patient's C-Spine and construct obtained.
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F3
Rods were placed in a unique "X" fashion to accommodate the unusual anatomy [Figure 3].
CT scan, bone window, sagittal views. (a) Preoperative imaging. (b) Immediate post-operative imaging. Notice the realignment and decompression obtained, highlighted by the blue angled lines.
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F4
Postoperative MR/CT imaging confirmed complete decompression of the neural structures, partial realignment of the previous deformity, and correct construct positioning [Figure 4].