The patient is status post posterior decompression with instrumentation posterior fixation spanning from the occiput to the visualized thoracic spine. The occipital plate is inferiorly displaced compared to the bone and the three midline screws have all completely backed out and are in the soft tissues (red arrows).

A

B

Some additional findings include lucency throughout the length of the left C1 screw consistent with infection (image A) as well as a fluid collection in the posterior paraspinal tissues (image B). Such profound lucency and instrumentation failure should be considered highly suspicious for infection.