This is a 75 year-old female with a history of rheumatoid arthritis presents to office with several years of progressive neck pain. She also reports 3 months of numbness in her hands; denies weakness but reports apraxia. She also report ataxia – feels off balance. Her neurological examination reveals loss of sensation in her hands and hyperreflexia.
Sagittal (left) and axial (right) MRI images obtained 4 years pre-op. They show development of a soft tissue mass behind the odontoid process of C2 (yellow arrow). It is compressing the spinal cord (orange star).
: Sagittal MRI images obtained just prior to surgery. They show a stable soft tissue mass behind the odontoid process of C2 (compare with Figure 1). It is compressing the spinal cord (yellow arrow on left). There is also evidence of instability at C1-2. Additionally, there is disc displacement at C5/6 causing some canal stenosis (yellow arrow on right).
Axial MRI images obtained pre-op. They show compression of the spinal cord (orange star) with edema (white signal) within the cord itself; consistent with myelomalacia.
A fluoroscopic image acquired during an epidural steroid injection. The patient received some relief from her right leg pain, but it was short-lived.
Sagittal (left) and axial (right) CT images showing the bony anatomy of the cervical spine and C1 (right image).
Images captured from the intraoperative stereotactic navigation system. It demonstrates the placement of the left C1 screw using image-guidance.
Images captured from the intraoperative stereotactic navigation system. It demonstrates the placement of the left C2 screw using image-guidance.
Postoperative x-rays showing the final C1-2 construct in open-mouth AP (left) and lateral (right) views.