Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Spine Case

C1-2 fusion

C1-2 instability with rheumatic pannus 75 year-old woman with history of rheumatoid arthritis presents to office with several years of progressive neck pain. Also reports 3 months of numbness in her hands; denies weakness but reports apraxia

Description

C1-2 instability with rheumatic pannus 75 year-old woman with history of rheumatoid arthritis presents to office with several years of progressive neck pain. Also reports 3 months of numbness in her hands; denies weakness but reports apraxia

Gallery

Images

Figure 1Sagittal (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).
Figure 2Sagittal MRI images obtained
Figure 3Axial 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 .
Figure 4Sagittal (left) and axial (right) CT images showing the bony anatomy of the cervical spine and C1 (right image).
Figure 5Images obtained from CT angiogram (CTA) of the neck obtained preop . The course of the vertebral artery is demonstrated on each side as it courses around the lateral mass of C1 (yellow arrow). Also noted is a calcification within the internal carotid artery (blue star)
Figure 6Images captured from the intraoperative stereotactic navigation system. It demonstrates the placement of the left C1 screw using image-guidance.
Figure 7Images captured from the intraoperative stereotactic navigation system. It demonstrates the placement of the left C2 screw using image-guidance.
Figure 8Postoperative x-rays showing the final C1-2 construct in open-mouth AP (left) and lateral (right) views.

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