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Walavan Sivakumar, J. Bradley Elder and Mark H. Bilsky

radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy . Spine (Phila Pa 1976) 18 : 2167 – 2173 , 1993 5 Birch BD , Khandji AG , McCormick PC : Atlantoaxial degenerative articular cysts . J Neurosurg 85 : 810 – 816 , 1996 6 Cartwright MJ , Nehls DG , Carrion CA , Spetzler RF : Synovial cyst of a cervical facet joint: case report . Neurosurgery 16 : 850 – 852 , 1985 7 Cho BY , Zhang HY , Kim HS : Synovial cyst in the cervical region causing severe myelopathy . Yonsei Med J 45 : 539 – 542

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Paul Klimo Jr., Valerie Coon and Douglas Brockmeyer

images there was no spinal cord signal change or syringohydromyelia, and the VA anatomy was normal ( Fig. 1A ). A CT scan confirmed the presence of an os odontoideum. The os fragment was fused to the posterior aspect of C-1, consistent with a dystopic os odontoideum ( Fig. 1B and C ). There was no abnormal atlantoaxial motion on flexion, but with extension, the patient had posterior subluxation of 9–10 mm (posterior instability, Fig. 1D and E ). We concluded that although her os odontoideum was discovered incidentally, surgical fusion was indicated because she showed

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Dueng-Yuan Hueng, Chia-Lin Tsai, Shih-Wei Hsu and Hsin-I Ma

utility and therapeutic effectiveness of cervical facet joint interventions . Pain Physician 12 : 323 – 344 , 2009 31 Farrokhi MR , Torabinezhad S , Ghajar KA : Pilot study of a new acrylic cage in a dog cervical spine fusion model . J Spinal Disord Tech 23 : 272 – 277 , 2010 32 Fessler RG : Outcome analysis in lumbar spine: instabilities/degenerative disease . Clin Neurosurg 44 : 297 – 303 , 1997 33 Finn MA , Apfelbaum RI : Atlantoaxial transarticular screw fixation: update on technique and outcomes in 269 patients . Neurosurgery

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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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Hermann Neugebauer, Jens Witsch, Klaus Zweckberger and Eric Jüttler

M , Inoue N , Nagatani T , Takagi T : Cerebellar stroke due to vertebral artery occlusion after cervical spine trauma. Two case reports . Spine (Phila Pa 1976) 19 : 83 – 88 , 1994 83 Miyata I , Imaoka T , Masaoka T , Nishiura T , Ishimitsu H : Pediatric cerebellar infarction caused by atlantoaxial subluxation—case report . Neurol Med Chir (Tokyo) 34 : 241 – 245 , 1994 84 Mohsenipour I , Gabl M , Schutzhard E , Twerdy K : Suboccipital decompressive surgery in cerebellar infarction . Zentralbl Neurochir 60 : 68

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Justin K. Scheer, Jessica A. Tang, Justin S. Smith, Frank L. Acosta Jr., Themistocles S. Protopsaltis, Benjamin Blondel, Shay Bess, Christopher I. Shaffrey, Vedat Deviren, Virginie Lafage, Frank Schwab, Christopher P. Ames and the International Spine Study Group

, Guan Y , Pintar F : Importance of physical properties of the human head on head-neck injury metrics . Traffic Inj Prev 10 : 488 – 496 , 2009 112 Yoshida G , Kamiya M , Yoshihara H , Kanemura T , Kato F , Yukawa Y , : Subaxial sagittal alignment and adjacent-segment degeneration after atlantoaxial fixation performed using C-1 lateral mass and C-2 pedicle screws or transarticular screws. Clinical article . J Neurosurg Spine 13 : 443 – 450 , 2010 113 Yoshimoto H , Ito M , Abumi K , Kotani Y , Shono Y , Takada T

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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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Zachary L. Hickman, Michael M. McDowell, Sunjay M. Barton, Eric S. Sussman, Eli Grunstein and Richard C. E. Anderson

with posterior decompression alone. However, if an anterior approach is still required, the transnasal endoscopic approach can be readily performed with the neck in the neutral position. TABLE 1: Presenting characteristics and operative complications in pediatric patients undergoing endoscopic transnasal odontoidectomy Case No. Authors & Year Age (yrs), Sex Medical History Indication for Op Presenting Symptoms Op Complications 1 Magrini et al., 2008 11, M Down syndrome atlantoaxial subluxation, os odontoideum

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Bruno C. Flores, Benjamin P. Boudreaux, Daniel R. Klinger, Bruce E. Mickey and Samuel L. Barnett

and the posterior atlantooccipital membrane. The dorsal ramus of the C-1 nerve root and the horizontal segment of V 3 are buried in an abundant areolar tissue, lying deep in this triangle. 31 In the atlantoaxial region, the vertical segment of V 3 and the C-2 nerve are located in the inferior suboccipital triangle, delineated by the obliqus capitis inferior, semispinalis, and splenius cervicis muscles. The V 4 segment corresponds to the intradural portion of the vessel extending to the vertebrobasilar confluence. The VA lies posterior and medial to the

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Amjad Nasr Anaizi, Anousheh Sayah, Frank Berkowitz and Kevin McGrail

neurological symptoms secondary to intermittent vertebral artery occlusion during head rotation. It is often occlusion of the dominant vertebral artery that is responsible for a patient's symptoms. Our case is unique because it was occlusion of the nondominant vertebral artery that resulted in the patient's symptoms. Vertebral artery occlusion can be secondary to osteophytes, ligamentous bands, C1–2 instability, or unusual vertebral artery anatomy. Vertebral artery occlusion occurs most often at the level of the atlantoaxial junction. The consequences of these intermittent