case_images: PMC11823873_01
case_images: Pre-operative clinical photograph.
case_images: JOCR-15-167-g001.jpg
case_images: PMC11823873_01_JOCR-15-167-g001.jpg
case_images: F1
case_images: A 49-year-old gentleman presented to our orthopaedic outdoors with gradually progressive quadriparesis associated with multiple lesions all over the body, which were present since birth (Fig. 1).
case_images: Pre-operative radiograph before skull traction.
case_images: JOCR-15-167-g002.jpg
case_images: PMC11823873_01_JOCR-15-167-g002.jpg
case_images: F2
case_images: Lateral dynamic radiographs revealed atlantoaxial instability, with an alteration of the relationship of the atlas to the axis (Fig. 2).
case_images: Pre-operative radiograph after skull traction.
case_images: JOCR-15-167-g003.jpg
case_images: PMC11823873_01_JOCR-15-167-g003.jpg
case_images: F3
case_images: A pre-operative radiograph after skull traction suggested reducibility (Fig. 3).
case_images: Pre-operative computed tomography scan (sagittal view).
case_images: JOCR-15-167-g004.jpg
case_images: PMC11823873_01_JOCR-15-167-g004.jpg
case_images: F4
case_images: A computed tomography scan confirmed an increased distance (12.7 mm) between the anterior arch of the atlas and the dens (Fig. 4 and 5).
case_images: Pre-operative computed tomography scan (axial view).
case_images: JOCR-15-167-g005.jpg
case_images: PMC11823873_01_JOCR-15-167-g005.jpg
case_images: F5
case_images: A computed tomography scan confirmed an increased distance (12.7 mm) between the anterior arch of the atlas and the dens (Fig. 4 and 5).
case_images: Pre-operative computed tomography angiography.
case_images: JOCR-15-167-g006.jpg
case_images: PMC11823873_01_JOCR-15-167-g006.jpg
case_images: F6
case_images: Pre-operative angiography was done to examine the arterial and venous structures near the C1-C2 region (Fig. 6 and 7).
case_images: Pre-operative magnetic resonance imaging angiography.
case_images: JOCR-15-167-g007.jpg
case_images: PMC11823873_01_JOCR-15-167-g007.jpg
case_images: F7
case_images: Pre-operative angiography was done to examine the arterial and venous structures near the C1-C2 region (Fig. 6 and 7).
case_images: Pre-operative magnetic resonance imaging (T1W).
case_images: JOCR-15-167-g008.jpg
case_images: PMC11823873_01_JOCR-15-167-g008.jpg
case_images: F8
case_images: Magnetic resonance imaging revealed a decreased spinal canal diameter and narrowing of the cord (Fig. 8 and 9).
case_images: Pre-operative magnetic resonance imaging (T2W).
case_images: JOCR-15-167-g009.jpg
case_images: PMC11823873_01_JOCR-15-167-g009.jpg
case_images: F9
case_images: Magnetic resonance imaging revealed a decreased spinal canal diameter and narrowing of the cord (Fig. 8 and 9).
case_images: Fusion done using local + iliac crest bone graft.
case_images: JOCR-15-167-g010.jpg
case_images: PMC11823873_01_JOCR-15-167-g010.jpg
case_images: F10
case_images: After the insertion of screws, the posterior surfaces of the laminae and arch of the atlas were decorticated, and a bone graft (local + iliac crest) was placed (Fig. 10).
case_images: Post-operative radiograph.
case_images: JOCR-15-167-g011.jpg
case_images: PMC11823873_01_JOCR-15-167-g011.jpg
case_images: F11
case_images: Post-operative radiographs, computed tomography and magnetic resonance imaging, revealed a satisfactory outcome (Fig. 11-15).
case_images: Post-operative computed tomography scan (sagittal view).
case_images: JOCR-15-167-g012.jpg
case_images: PMC11823873_01_JOCR-15-167-g012.jpg
case_images: F12
case_images: Post-operative radiographs, computed tomography and magnetic resonance imaging, revealed a satisfactory outcome (Fig. 11-15).
case_images: Post-operative computed tomography scan (axial view).
case_images: JOCR-15-167-g013.jpg
case_images: PMC11823873_01_JOCR-15-167-g013.jpg
case_images: F13
case_images: Post-operative radiographs, computed tomography and magnetic resonance imaging, revealed a satisfactory outcome (Fig. 11-15).
case_images: Post-operative magnetic resonance imaging (T1W).
case_images: JOCR-15-167-g014.jpg
case_images: PMC11823873_01_JOCR-15-167-g014.jpg
case_images: F14
case_images: Post-operative radiographs, computed tomography and magnetic resonance imaging, revealed a satisfactory outcome (Fig. 11-15).
case_images: Post-operative magnetic resonance imaging (T2W).
case_images: JOCR-15-167-g015.jpg
case_images: PMC11823873_01_JOCR-15-167-g015.jpg
case_images: F15
case_images: Post-operative radiographs, computed tomography and magnetic resonance imaging, revealed a satisfactory outcome (Fig. 11-15).