Occipitocervical collision after C1–C2 fusion

Abstract

A 54-year-old woman presented with a 10-year history of neck pain. On medical history, she suffered from rheumatoid arthritis for several years. Plain X-ray imaging showed increased atlantodental interval as 9 mm (Fig. 1). Postoperative X-ray study shows that C1–C2 fixation was done using bilateral C1 lateral mass, left C2 intralaminar, and right C2 pedicle screws. Her neck pain disappeared immediately after surgery. However, the distance between occiput and posterior C1 arch was decreased compared with preoperative X-ray imaging because C1–C2 fixation was done in distracted position and oversized iliac bone graft was placed between the C1 and C2 posterior arch (Fig. 2). Twenty-seven months later, she revisited the outpatient clinic because of severe occipital headache