Audrey Martin was a normal, happy 5-year-old girl, active in ballet, soccer and gymnastics. Outside of recurring ear infections and occasional snoring, Audrey was in perfect health. Audrey's doctor suspected enlarged adenoids were the cause of her snoring. However, a routine X-ray revealed an abnormality in her cervical spine (neck area), and she was subsequently diagnosed with atlantoaxial subluxation of the 1st and 2nd cervical vertebrae.

Atlantoaxial subluxation is a condition in which the vertebrae of the cervical spine are malaligned, with the potential to cause nerve damage, paralysis or even death. Rarely diagnosed in someone as young as Audrey, the condition is most often seen as a result of traumatic injury or rheumatoid arthritis.

Audrey was born with this condition. When she sat or stood without turning and looked straight ahead, her neck bones lined up properly. But when she tilted her chin toward her chest, the bones shifted her vertebrae 8 mm toward her spinal cord in a 12 mm space. The protruding odontoid or "tooth" on the vertebra was only millimeters from compressing (putting pressure on) Audrey's spinal cord.

Audrey's diagnosis was shocking and scary because she showed no signs of neurological problems and had excellent coordination. However, the degree of movement of Audrey's vertebra toward her spinal cord put her at risk for spinal cord injury. "Because of her age and activity level, we lived in fear from day to day, worrying about how her life could change after a fall or an attempted somersault, or if we applied the car brakes too hard. Any extreme movement of her chin towards her chest narrowed the space even further," Audrey's mother Lynette explains.

Anthony Avellino, MD, a neurosurgeon at Seattle Children's Hospital, presented Audrey's MRI and CT scans to a team of neurosurgeons and orthopaedic surgeons at the University of Washington. They agreed that a spinal fusion to immobilize the affected joints was necessary to allow Audrey to lead a normal life.

Two attempts were required to stabilize Audrey's condition. Her first spinal fusion surgery was in May 2003. Unfortunately, the bone graft failed to fuse (grow together) and the surgery was unsuccessful, possibly due to the micro-movements allowed by the neck collar brace and non-optimal placement of stabilizing screws. At the time of her surgery, an interoperative CT scanner - which would have made it easier for her doctor to see where to place the screws - was not available. As Lynette explains, "it is only through the sharing of information and statistics between doctors, and more research, that this could be determined to be true."

In September 2003, a second, more aggressive approach was taken with the spinal fusion surgery. Orthopaedic surgeon Sohail Mirza, MD, joined the surgical team, and, guided by an interoperative CT scanner, used a bone graft, wire hardware and small screws originally intended for use in the hands and feet. Audrey was then fitted for a halo brace, which kept the bones in place while they healed. She wore the brace, which immobilized her body from the chest up, for 10 weeks.

In December 2004, Audrey celebrated her one-year anniversary with a safe neck, and Audrey's family has the security of knowing she can lead a life free from the fear of paralysis. The Martins hope that some day other children will benefit from the advanced technologies that helped Audrey.

The Martins believe interoperative CT scanners for spinal surgeries are imperative for successful outcomes. In addition, they strongly advocate the creation of a federally funded National Spine Database to share results, statistics and spine information between physicians, patients and hospitals for more positive outcomes.