PMC6503600_01
(a) Lateral radiographs before surgery showing that C1 is displaced
anteriorly relative to C2. (b and c) Three-dimensional computed tomography
(CT) images showing that C2 is fractured at the vertebral body, the right
atlantoaxial joint and the transverse foramen.
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A cervical spine radiograph (Figure 1(a)) and computed tomography (CT) scans (Figure 1(b) and (c)) showed C1-C2 fracture dislocation. Fractures were observed at the odontoid process, C2 transverse foramen, vertebral body, and right atlantoaxial joint (Figures 1(b) and (c) and 2(b)). C2, with an irreducible intra-articular fracture of the right atlantoaxial joint (Figure 1(c) and 2(a)). CT angiography showed bilateral high-riding VAs (Figure 2(a), (b), (d), and (f)).
Computed tomography (CT) angiography images before surgery. (a, b and c)
Sagittal, (e) axial and (d and f) oblique three-dimensional images showing
high-riding vertebral arteries (VAs; arrow).
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C2, with an irreducible intra-articular fracture of the right atlantoaxial joint (Figure 1(c) and 2(a)). CT angiography showed bilateral high-riding VAs (Figure 2(a), (b), (d), and (f)).
(a) Postoperative lateral radiographs showing good reduction of dislocation.
Postoperative axial computed tomography (CT) images 3 days after surgery
showing correct placement of the implants at (b) C1 and (c) C2.
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The postoperative lateral plain radiograph showed normal alignment of C1-C2 on the lateral image (Figure 3(a)), and postoperative axial CT images showed correct placement of the C1 LMS and LS (Figure 3(b)) and the C2 PS and LS (Figure 3(c)).
(a) Sagittal and axial CT images of (b) C1 and (c) C2 at 8 months after
surgery showing healing of the odontoid fracture with anatomically correct
alignment.
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Eight months after the surgery, CT scans showed healing of the odontoid fracture with anatomically correct alignment and posterior fusion between the C1 posterior arch and C2 lamina (Figure 4), with no loosening of the C1 LMS and LS and the C2 PS and LS.
Lateral radiograph at 2 years after surgery.
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Two years later, the patient was in good condition, having only slight neck pain when extending the cervical spine (Figure 5).