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and had minimum follow-up of two-years. Diagnosis, levels fused, rhBMP-2 dose, complications, and fusion (Lenke grade applied by two neuroradiologists) were assessed. Results: 53 patients (22 men/31 women) met inclusion criteria, with a mean age of 55.7 years and an average follow-up of 40 months. Surgical indications included basilar invagination (n=6), fracture (n=6), atlanto-axial instability (n=16), kyphosis/kyphoscoliosis (n=22), osteomyelitis (n=1), spondylolisthesis (n=1), cyst (n=1). 15 patients had confirmed rheumatoid disease. The average rhBMP-2

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querying the Cochrane Collaboration, Educus journal search, PubMed, and Google Scholar databases using the following phrases: “spine injury return to play,” “cervical spine injury athletes,” and “return to play thoracolumbar.” Additionally relevant references from these articles were reviewed. Results: All recommendations represent level III evidence. Absolute contraindications for return to play include atlantoaxial fusions, occipitalcervical fusions, atlantodental interval >3mm adult (> 4mm child),acute herniated discs, discs with pain and neurologic deficits

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Ziev B. Moses, Rory R. Mayer, Benjamin A. Strickland, Ryan M. Kretzer, Jean-Paul Wolinsky, Ziya L. Gokaslan and Ali A. Baaj

: an initial clinical experience . Neurosurgery 51 : 5 Suppl Minimally Invasive Spine Surgery S37 – S45 , 2002 6 Gelalis ID , Paschos NK , Pakos EE , Politis AN , Arnaoutoglou CM , Karageorgos AC , : Accuracy of pedicle screw placement: a systematic review of prospective in vivo studies comparing free hand, fluoroscopy guidance and navigation techniques . Eur Spine J 21 : 247 – 255 , 2012 7 Grob D , Jeanneret B , Aebi M , Markwalder TM : Atlanto-axial fusion with transarticular screw fixation . J Bone Joint Surg Br 73

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Camilo A. Molina, Christopher P. Ames, Dean Chou, Laurence D. Rhines, Patrick C. Hsieh, Patricia L. Zadnik, Jean-Paul Wolinsky, Ziya L. Gokaslan and Daniel M. Sciubba

cervical atlantoaxial (C1–2) tumors present challenges that are different from those presented by subaxial (C3–7) tumors. For example, atlantoaxial chordomas frequently involve both the cervical roots and vertebral arteries. Although the C1–4 roots can generally be sacrificed without ensuing neurological deficit, vertebral artery sacrifice can result in significant neurological deficits, particularly if the dominant vertebral artery is sacrificed in the setting of insufficient collateral flow. Tumors that do not involve the vertebral arteries bilaterally are more

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Michelle J. Clarke, Patricia L. Zadnik, Mari L. Groves, Daniel M. Sciubba, Timothy F. Witham, Ali Bydon, Ziya L. Gokaslan and Jean-Paul Wolinsky

, Gokaslan ZL : Management of atlantoaxial metastases with posterior occipitocervical stabilization . J Neurosurg 98 : 2 Suppl 165 – 170 , 2003 11 Fujita T , Kawahara N , Matsumoto T , Tomita K : Chordoma in the cervical spine managed with en bloc excision . Spine (Phila Pa 1976) 24 : 1848 – 1851 , 1999 12 George B , Archilli M , Cornelius JF : Bone tumors at the cranio-cervical junction. Surgical management and results from a series of 41 cases . Acta Neurochir (Wien) 148 : 741 – 749 , 2006 13 Hsieh PC , Galia GL , Sciubba

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Benjamin D. Elder, Wataru Ishida, C. Rory Goodwin, Ali Bydon, Ziya L. Gokaslan, Daniel M. Sciubba, Jean-Paul Wolinsky and Timothy F. Witham

Spine J 17 : 600 – 609 , 2008 43 Mahajan A : Normal tissue complications from low-dose proton therapy . Health Phys 103 : 586 – 589 , 2012 44 Matsumoto M , Watanabe K , Tsuji T , Ishii K , Nakamura M , Chiba K , : Late instrumentation failure after total en bloc spondylectomy . J Neurosurg Spine 15 : 320 – 327 , 2011 45 Menezes AH , Ahmed R : Primary atlantoaxial bone tumors in children: management strategies and long-term follow-up . J Neurosurg Pediatr 13 : 260 – 272 , 2014 46 Metcalfe S , Gbejuade H , Patel

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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