Page 1629 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

1148 PART 10: The Surgical Patient

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FIGURE 119-15. (1) Sagittal CT image showing C5 burst fracture and severe ligamentous injury in a patient who fell while at work rendering him quadriplegic. He underwent staged anterior
corpectomies of C5 and C6 followed by cervical laminectomies and lateral mass instrumentation and fusion C3 through C7. Final anterior construct imaging on (2) sagittal and (3) coronal views.
(4) Sagittal CT image of the lateral mass screws.

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FIGURE 119-16. (1) Midline sagittal CT image of patient with bilateral C7-T1
facet dislocation with posterior ligamentous injury splaying spinous processes at
these levels. (2, 3) Sagittal CT images of both C7 facets which are locked over the
superior articulating processes of T1 (see arrows). This injury failed to reduce with
traction and the patient underwent open surgical reduction by drilling off the locked
inferior articulating process of C7 (see arrow) and a combination of lateral mass, pedicle
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screw, and spinous process wiring to T2 (4). Normal alignment was obtained (5).

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