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Peng-Yuan Chang, Jau-Ching Wu, Wen-Cheng Huang, Tsung-Hsi Tu and Henrich Cheng

T o T he E ditor : We read with great interest the article by Dr. Suh and colleagues 7 (Suh BG, Padua MRA, Riew KD, et al: A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation. Clinical article. J Neurosurg Spine 19: 160–166, August 2013). They introduced a novel technique using a T-shaped rod tool to facilitate reduction after the placement of screws in C-1 and C-2. We found their surgical pearl of substantial value in practical use. However, a few questions need answering before the

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Yu-Shu Yen, Peng-Yuan Chang, Wen-Cheng Huang, Jau-Ching Wu, Muh-Lii Liang, Tsung-Hsi Tu and Henrich Cheng

A lthough transoral odontoidectomy has been accepted as the treatment of choice in the surgical management of basilar invagination, 10 , 21–23 , 25 , 33 alternative approaches are emerging, including the reduction of atlantoaxial subluxation from posterior 8 , 9 , 27 , 32 and endoscopic approaches for decompression at the ventral cervicomedullary junction. 4 , 19 , 29 , 36 , 37 The feasibility of endoscopic transnasal odontoidectomy (ETO) has been demonstrated in cadaveric studies. 1 , 24 In the past several years, there also have been case reports of

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Peng-Yuan Chang, Yu-Shu Yen, Jau-Ching Wu, Hsuan-Kan Chang, Li-Yu Fay, Tsung-Hsi Tu, Ching-Lan Wu, Wen-Cheng Huang and Henrich Cheng

brainstem and malalignment of theCVJ. 14 , 15 , 18 , 22 , 24 , 28–34 , 40 These deformities might require both anterior decompression and posterior fixation to achieve adequate correction. 12 , 44–46 Despite the innovation of various routes for odontoidectomy (e.g., transnasal, transoral, transcervical, and combined), there is a paucity of data addressing biomechanical instability after odontoidectomy. The best timing and choices of and the necessity for occipitocervical (OC) or atlantoaxial (AA) fusion after odontoidectomy are still not clear. In this study, we

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orthosis, 2 with a Minerva brace, and 1 with a halo. Two patients required cervical surgery; an occipital cervical fusion for a type 2 odontoid fracture and one atlantoaxial fusion for atlantoaxial instability was performed. At the follow up appointments, none of the patients were found to have delayed instability based on clinical examination, upright x-rays or flexion-extension x-rays. Conclusion: All isolated OCF are likely stable injuries. Our data suggests all isolated OCF may be treated conservatively with any type of cervical orthosis and minimal follow up