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Figure 1: Pre-operative MRI Cervical spine showed narrowing of the cord at CVJ with T2 hyperintensities (a) with uniformly enhancing extradural lesion extending through the C1-2 foramen in post contrast T1 axial image (b, black arrow). CT spine image showed thin left C1 lateral and narrow C1-2 joint space (c) with C2 pars defect and multiple osteophytes (d). CT cervical spine done post botulinum toxin and traction showed alignment of C1-2 joint with improved and increased joint space (e). Post-surgery lateral cervical spine x-ray showing right C1- C2 fixation with C1 lateral mass and C2 transpedicular screw and left Occipito-C2 fixation with C2 laminar screw(f). Evidence of 4 months post op fusion is evident in form of trabeculations across joint space and the bone graft (g and h)

Figure 1: Pre-operative MRI Cervical spine showed narrowing of the cord at CVJ with T2 hyperintensities (a) with uniformly enhancing extradural lesion extending through the C1-2 foramen in post contrast T1 axial image (b, black arrow). CT spine image showed thin left C1 lateral and narrow C1-2 joint space (c) with C2 pars defect and multiple osteophytes (d). CT cervical spine done post botulinum toxin and traction showed alignment of C1-2 joint with improved and increased joint space (e). Post-surgery lateral cervical spine x-ray showing right C1- C2 fixation with C1 lateral mass and C2 transpedicular screw and left Occipito-C2 fixation with C2 laminar screw(f). Evidence of 4 months post op fusion is evident in form of trabeculations across joint space and the bone graft (g and h)