Odontoid fractue- pre op and postop radiology

20 year old male with history of fall from bike presented with complaints of severe neck pain and bilateral upper and lower limb weakness ( power 4/5) with brisk reflexes. His CT and mri cervical spine is as shown above s/o type 2 odontoid fracture with retropulsion of lower fragment in cervical canal, he also had tibia fracture. It was decided to do posterior c1, c2 fusion , this surgery is very risky slight deviation of screw medially can injure cord and cause quadriparesis and slight displacement laterally can injure vertebral artery and cause torential bleeding and brainstem infract; for this surgery prescise planning was neeeded. I preoperatively done 3D CT cervical spine with vertebral angiography as shown in figure. On 3D reconstruction i found vertebral artery is having normal course and trajectory, length and thickness of screws was preoperatively planned. Patient was posted for surgery in prone position and cervical traction was given. Intubation was tricky because more extension could cause cord compression and quadriplegia, intubation was expertly done by our anesthesist.During surgery while placing c1 screw i found because of odontoid fracture c1 posterior arch is compressing on cervical cord so its risky hence i decided to do c2 occiput fusion after odontoid fracture reduction. As shown in post op CT CV junction, C2 screw is precisely placed with no medial or lateral breach as well as odontoid fracture is reduced and there is no cord compression. I have partially drilled and decorticated c1 and c2 posterior arches and brought close and fused with bone graft. With occipital fusion there is slight reduction in flexion hence after 1 year and confirmation of fusion of fracture if patient desires i can remove implant. Entire operative procedure was smooth without any complication, After surgery patients cervical pain and spasm is reduced and patient is mobilised with support his power in all 4 limbs is 5/5. Now patient has no problem. Thank you.