case_images: PMC5591568_01
case_images: Initial diagnostic workup of the cervical spine injury with CT (panels a-f) and MRI (panels G,H). The sagittal views in panels a-d demonstrate the fracture dislocation with the left sided perched facet (panel c, and arrow in panel b) and the right sided facet fracture-dislocation (panel d). The posterior traumatic laminotomy is shown in axial CT images of C6 (panel e) and C7 (panel f). Panels g and h are sagittal STIR-weighed MRI images of the cervical spine, demonstrating the extruded C7/T1 disc within the spinal canal (panel h is a magnification of panel g
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case_images: PMC5591568_01_13037_2017_139_Fig1_HTML.jpg
case_images: Fig1
case_images: T1, with rotational instability (AO/OTA classification 51-C2.1). The injury pattern included a C7/T1 fracture-dislocation (Fig. 1a) with a left-side locked/perched facet at C6/C7 (Fig. 1b,c), a right side facet fracture-dislocation at C7/T1 (Fig. 1d), and a "saving" traumatic laminotomy at C6 and C7 on right side (Fig. 1e,f). The MRI demonstrated a complete disruption of the annulus fibrosus of the C7/T1 intervertebral disc, a disruption of the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL) at the same level, and a complete extrusion of the C7/T1 disc into the spinal canal, positioned behind the C7 vertebral body (Fig. 1g,h).
case_images: Lateral radiograph of the cervical spine after posterior C4-T1 fusion and anterior C7 corpectomy and fusion
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case_images: PMC5591568_01_13037_2017_139_Fig2_HTML.jpg
case_images: Fig2
case_images: The previous anterior cervical wound was re-opened. The exposed dura was visualized through the preceding C7 corpectomy, and a 2-level anterior fusion from C6-T1 was performed with a PEEK cage filled with autograft bone from the resected C7 vertebra, and placement of a 2-level anterior locking plate (Fig. 2). The anterior wound was then closed, the
case_images: The patient and his wife giving a "thumbs up" in the surgical intensive care unit on postoperative day 1 after spinal fusion and Halo removal
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case_images: PMC5591568_01_13037_2017_139_Fig3_HTML.jpg
case_images: Fig3
case_images: He tolerated the procedure well and was extubated in the operating room. His neurological exam was normal and the hypoesthesia in the right C8 dermatoma resolved postoperatively (Fig. 3).
case_images: The patient depicted on his first street bicycle race at 10 months post injury, with an accompanying letter of gratitude
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case_images: PMC5591568_01_13037_2017_139_Fig4_HTML.jpg
case_images: Fig4
case_images: He was back riding his bicycle at 7 months, and by 10 months after surgery he had returned to competitive street bicycle racing in the 100 mile "Elephant Rock Century Ride" in Castle Rock, Colorado (Fig. 4).