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Figure 3: Unlike the case presented in Figure 2, this patient had a very severe BI and AAD leading to severe cord compression (a). CT scan through the joints (b) showed joints, which were completely vertical (arrow head). However, this led to development of a pseudo-articulation between the upper surface of C2 lamina and the occiput (right arrow,b). This allowed the placement of a spacer in this space (extra articular distraction, c). Since the BI and AAD were very severe, an additional purchase of C3, C4, C5 lateral masses were taken. Following DCER, realignment was attained and the compression was completely relieved (d)

Figure 3: Unlike the case presented in Figure 2, this patient had a very severe BI and AAD leading to severe cord compression (a). CT scan through the joints (b) showed joints, which were completely vertical (arrow head). However, this led to development of a pseudo-articulation between the upper surface of C2 lamina and the occiput (right arrow,b). This allowed the placement of a spacer in this space (extra articular distraction, c). Since the BI and AAD were very severe, an additional purchase of C3, C4, C5 lateral masses were taken. Following DCER, realignment was attained and the compression was completely relieved (d)