Open AccessIntraoperative Computed Tomography Scanner-Guided Craniovertebral Junction Surgery in a Patient with an Occipitalized C1
Author(s) -
Mohammad Ashraf,
Usman Ahmad Kamboh,
Naveed Ashraf
Publication year - 2021
Publication title -
journal of neurosciences in rural practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.331
H-Index - 22
eISSN - 0976-3147
pISSN - 0976-3155
DOI - 10.1055/s-0041-1730088
Subject(s) - medicine , basilar invagination , fixation (population genetics) , surgery , malunion , decompression , lateral mass , nonunion , computed tomography , odontoid process , radiology , cervical spine , population , environmental health
Craniovertebral junction surgery is associated with unique difficulties. Type 2 odontoid fractures (Anderson and D Alonzo) have a great potential for nonunion and malunion. These fracture patients may require a circumferential decompression and fixation. The addition of intraoperative CT with neuronavigation greatly aids in craniovertebral junction surgery. We operated on a 59-year-old-male with a type 2 fracture with posterior subluxation of C1 anterior arch and a cranially displaced odontoid peg. First, a transoral odontoidectomy was performed followed by a craniocervical fixation. Occipital plates and C3–C4 lateral mass screws were used as C1 was discovered to be occipitalized intraoperatively and atlantoaxial facet joints could not be reduced as discovered by intraoperative CT resconstruction. Intraoperative CT scan was crucial to this circumferential decompression and fixation, allowed us to resect the odontoid peg safely and completely and to confirm adequate screw trajectory making this complex surgery easier for us and safer for the patient. The patient was discharged 4 months after admission with stable neurology. Intraoperative CT was fundamental to correct decision making.