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Sui-To Wong, Kimberly Ernest, Grace Fan, John Zovickian and Dachling Pang

I solated alar ligament rupture is rare. Most cases of alar ligament rupture are seen in the context of atlantooccipital dislocation, condylar fractures, and atlantoaxial rotatory fixation. 1 , 3 , 9 , 15 , 18 Only 6 cases of isolated alar ligament rupture have been previously reported in the literature ( Table 1 ). 4 , 5 , 7 We are reporting a case of unilateral rupture of the alar ligament resulting from a fall in a 9-year-old child. TABLE 1: Summary of reported cases of isolated rupture of the alar ligament

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Vincent C. Traynelis, Jonathan Sherman, Eric Nottmeier, Vaneet Singh, Kirk McGilvray, Christian M. Puttlitz and Patrick Devin Leahy

Gorek J , Acaroglu E , Berven S , Yousef A , Puttlitz C : Constructs incorporating intralaminar C2 screws provide rigid stability for atlantoaxial fixation . Spine (Phila Pa 1976) 30 : 1513 – 1518 , 2005 9 Grip H , Sundelin G , Gerdle B , Stefan Karlsson J : Cervical helical axis characteristics and its center of rotation during active head and upper arm movements—comparisons of whiplash-associated disorders, non-specific neck pain and asymptomatic individuals . J Biomech 41 : 2799 – 2805 , 2008 10 Horn EM , Reyes PM , Baek

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Pravin Salunke, Sushanta K. Sahoo, Ramesh Doddamani, Chirag K. Ahuja and Kanchan K. Mukherjee

T raumatic atlantoaxial (C1–2) dislocation with Type II odontoid fracture is not uncommon. This usually occurs in the anteroposterior or sagittal plane. However, rotational and lateral C1–2 dislocation is rare. 5 , 9 The C1–2 facets may get locked, making the dislocation irreducible. We describe a rare case of irreducible C1–2 posterior and true lateral dislocation that was managed successfully by a direct posterior approach. The mode of injury and the method used to achieve intraoperative reduction are discussed. Case Report History and

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Kyeong Hwan Kim, Dong Bong Lee, Ho-Joong Kim, K. Daniel Riew, Boo Seop Kim, Bong-Soon Chang, Choon-Ki Lee and Jin S. Yeom

nerve roots, opening of the joints, and segmental fixation of the atlas and axis. 7 They extensively removed the articular surface of the C-1 and C-2 facets using a microdrill, distracted the facets using an intervertebral spreader, and inserted hydroxyapatite blocks or titanium spacers and bone graft in the facets. The final reduction was achieved using a plate and segmental screws. Similar techniques were used for the treatment of basilar invagination and fixed atlantoaxial dislocation in cases with congenital anomalies and in cases of rheumatoid arthritis by the

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713 10.3171/2014.2.SPINE1352 2014.2.SPINE1352 Rotational vertebral artery occlusion secondary to adjacent-level degeneration following anterior cervical discectomy and fusion Colin C. Buchanan Nancy McLaughlin Daniel C. Lu Neil A. Martin 6 2014 20 6 714 721 10.3171/2014.3.SPINE13452 2014.3.SPINE13452 Direct posterior reduction in a case of posttraumatic irreducible lateral atlantoaxial dislocation Pravin Salunke Sushanta K. Sahoo Ramesh Doddamani Chirag K. Ahuja Kanchan K. Mukherjee 6 2014 20 6 722 725 10.3171/2014.3.SPINE13806 2014.3.SPINE13806 High

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Michael M. McDowell, Simon J. Hanft, Sophie A. Greenberg, Rahmatullah Rahmati, Vincent Carrao, Sidney Eisig and Richard C. E. Anderson

anterior cervical approach to the upper cervical spine . Surg Neurol 68 : 519 – 524 , 2007 12 Patel AJ , Boatey J , Muns J , Bollo RJ , Whitehead WE , Giannoni CM , : Endoscopic endonasal odontoidectomy in a child with chronic type 3 atlantoaxial rotatory fixation: case report and literature review . Childs Nerv Syst 28 : 1971 – 1975 , 2012 13 Yildiz C , Erler K , Atesalp AS , Basbozkurt M : Benign bone tumors in children . Curr Opin Pediatr 15 : 58 – 67 , 2003

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Colin C. Buchanan, Nancy McLaughlin, Daniel C. Lu and Neil A. Martin

literature well before in what was referred to as cervical vertigo and characterized by vertigo, dizziness, and blurred vision with head rotation. 23 , 31 , 32 Mechanical compression of the VA during head rotation has been recognized to be a result of muscular or tendinous insertions, osteophytes, spondylosis, and segmental instability. 36 The most common level of compression is atlantoaxial. 2 , 17 This happens when the inferior facet of the atlas contralateral to the direction of rotation subluxates on the superior facet of the axis, thereby pulling the VA anteriorly

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Gabriel A. Smith, Arshneel S. Kochar, Sunil Manjila, Kaine Onwuzulike, Robert T. Geertman, James S. Anderson and Michael P. Steinmetz

cause of spinal cord compression: a review of 36 spinal epidural abscess cases . Acta Neurochir (Wien) 142 : 17 – 23 , 2000 4 Baaj AA , Alikhani P , Sack J , Vale FL , Greenberg MS : Drainage of a ventral epidural atlantoaxial abscess via the transoral approach . J Clin Neurosci 19 : 1044 – 1045 , 2012 5 Baker AS , Ojemann RG , Swartz MN , Richardson EP Jr : Spinal epidural abscess . N Engl J Med 293 : 463 – 468 , 1975 6 Banco SP , Vaccaro AR , Blam O , Eck JC , Cotler JM , Hilibrand AS , : Spine

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Shuichi Kaneyama, Taku Sugawara, Masatoshi Sumi, Naoki Higashiyama, Masato Takabatake and Kazuo Mizoi

R igid anchoring and fixation techniques in the C-2 vertebra have been reported since 1964 14 in the form of pedicle screws 5 , 14 and transarticular screws. 20 Because of the strong biomechanical structure of the C-2 vertebra, the use of anchor screws in these techniques has been widely accepted not only for atlantoaxial fixation but also for occipitocervical fixation or multiple segmental fixation to treat various cervical instability pathologies. 1–3 , 5 , 6 , 13 In addition to these techniques, safer options of screwing methods into C-2, such as

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Maria Koutourousiou, Francisco Vaz Guimaraes Filho, Tina Costacou, Juan C. Fernandez-Miranda, Eric W. Wang, Carl H. Snyderman, William E. Rothfus and Paul A. Gardner

evaluate the amount of basilar invagination, atlantoaxial dislocation, and brainstem/medulla compression. 15 According to Wang et al., 15 the normal CMA values range from 139° to 175.5°, with an average value of 158.46°, in accordance with our finding in the control group. Craniocervical junction pathologies, such as basilar invagination and atlantoaxial dislocation, compress the brainstem and medulla placing them in excessive kyphosis, which is recognized as a decreased CMA value on sagittal MRI. The cervicomedullary kyphosis noticed in our study group was a result of