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An 11-year-old male complains of one year duration of neck pain. He denies any recent trauma. He has noticed intermittent episodes of gait imbalance and difficulty with buttoning his shirt over the past 3 months. Physical exam shows normal strength in all four extremities and hyper-reflexic patellar tendons. Neutral and flexion radiographs are shown in Figures A and B. A sagittal CT scan is shown in Figure C with a coronal reconstruction shown in Figure D. What is the most appropriate treatment?
PT to strengthen the dynamic stabilizers of the neck
Soft collar wear during any athletic activities
Cessation of all contact sports with no surgical intervention
Posterior C1-C2 fusion
Anterior C1-2 fusion
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