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Lukas Bobinski, Marc Levivier and John M. Duff

Bilsky MH , Shannon FJ , Sheppard S , Prabhu V , Boland PJ : Diagnosis and management of a metastatic tumor in the atlantoaxial spine . Spine (Phila Pa 1976) 27 : 1062 – 1069 , 2002 3 Chung JY , Kim JD , Park GH , Jung ST , Lee KB : Occipitocervical reconstruction through direct lateral and posterior approach for the treatment of primary osteosarcoma in the atlas: a case report . Spine (Phila Pa 1976) 37 : E126 – E132 , 2012 4 Daniel RT , Muzumdar A , Ingalhalikar A , Moldavsky M , Khalil S : Biomechanical

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Jacob K. Greenberg, Eric Milner, Chester K. Yarbrough, Kim Lipsey, Jay F. Piccirillo, Matthew D. Smyth, Tae Sung Park and David D. Limbrick Jr.

B , Li D , Gu Y , : Surgical treatment of Chiari I malformation complicated with syringomyelia . Exp Ther Med 5 : 333 – 337 , 2013 10 Batzdorf U , McArthur DL , Bentson JR : Surgical treatment of Chiari malformation with and without syringomyelia: experience with 177 adult patients. Clinical article . J Neurosurg 118 : 232 – 242 , 2013 11 Behari S , Kalra SK , Kiran Kumar MV , Salunke P , Jaiswal AK , Jain VK : Chiari I malformation associated with atlantoaxial dislocation: focussing on the anterior cervico

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-0715 American Association of Neurological Surgeons 10.3171/2015.1.PEDSPAPER7 2015.1.PEDSPAPER1 Use of C1 Lateral Mass Screws in the Reduction of Atlanto-Axial Deformity: Technical Note Jonathan E. Martin , MD 3 2015 A345 A345 Copyright held by the American Association of Neurological Surgeons. You may not sell, republish, or systematically distribute any published materials without written permission from JNSPG. 2015 Introduction: C1 lateral mass screws (C1 LMS) coupled with C2 fixation are one of several options available

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Andrei F. Joaquim

invagination (BI) was harder to reduce with preoperative traction than cranial settling, because degeneration of the joints and ligaments can make reduction with traction easier in the latter. We have some comments regarding intraoperative reduction using posterior-only approaches for craniocervical junction instabilities. In 2010, Jian et al. published a report of 29 patients with BI and atlantoaxial dislocation successfully treated with distraction between the occipital plate and C-2. 2 They did not perform preoperative traction or the maneuver for anterior reduction of

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Maurizio Domenicucci, Demo Eugenio Dugoni, Cristina Mancarella, Alessandro D'Elia and Paolo Missori

with paraffin on the fracture surfaces, the vertebra was completely reconstructed. At this point in the text, the complete fracture lines were accurately described; moreover, the reassembly of the atlantoaxial articulation was described in terms of the pertinent anatomical and articular relationships. FIG. 2. Original photograph of page 244 of the paper written by Vincenzo Quercioli. Here, he reported the photographic documentation of an autopsy specimen regarding a fracture of the atlas. It is evident that symmetrical fractures in the anterior and posterior

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Alejandro J. Lopez, Justin K. Scheer, Kayla E. Leibl, Zachary A. Smith, Brian J. Dlouhy and Nader S. Dahdaleh

membrane. The atlantooccipital membrane contributes little to the stability of the CVJ. 29 , 34 , 35 Ceylan et al. analyzed the denticulate ligaments of the spinal column and found regional differences. 4 The cervical spine, particularly at the first denticulate ligament, featured widened triangular extensions and more robust collagen tissues, presumably to compensate for increased motion at this area. The Atlantoaxial Segment (C1–2) The atlas lacks a vertebral body and instead articulates with the odontoid process or dens, a bony protuberance extending

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Zhonghai Li, Fengning Li, Shuxun Hou, Yantao Zhao, Ningfang Mao, Tiesheng Hou and Jiaguang Tang

For stable Type I fractures, cervical hard collar immobilization for 8–14 weeks is generally recommended. Type II, IIA, and III fractures are considered to be unstable and require rigid immobilization. 14 , 15 In unstable hangman's fractures, hyperextension forces have resulted in disruption of the anterior longitudinal ligament, posterior longitudinal ligament, C2–3 intervertebral disc, and atlantoaxial joints. 6 , 14 The optimal management of unstable hangman's fractures remains controversial. In cases of significant displacement and instability, surgical

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Gregory F. Jost and Andrew T. Dailey

, 11 directions. TABLE 6 Outcome of decompression and/or fusion* Treatment Asymptomatic Sx Persistence Sx Recurrence Decompr 65/75 (87%) 6/75 (8%) 4/75 (5%) Fusion 14/14(100%) 0 0 Decompr & fusion 6/6(100%) 0 0 * Based on reports with available outcome data Fusion Thirteen (27%) of 48 patients with stenosis at C1–2 or distal to C-1 underwent atlantoaxial or occipitocervical fusion, 10 , 24 , 27 , 54 and 2 (3%) of 63 patients with compression at V 2 had fusion in the subaxial cervical spine 2

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Jörg Klekamp

invasive technique without posterior fusion . Eur Spine J 21 : Suppl 1 S55 – S60 , 2012 16 Goel A : Progressive basilar invagination after transoral odontoidectomy: treatment by atlantoaxial facet distraction and craniovertebral realignment . Spine (Phila Pa 1976) 30 : E551 – E555 , 2005 17 Goel A : Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation . J Neurosurg Spine 1 : 281 – 286 , 2004 18 Goel A , Bhatjiwale M , Desai K : Basilar invagination: a study based on

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Ulysses C. Batista, Andrei F. Joaquim, Yvens B. Fernandes, Roger N. Mathias, Enrico Ghizoni and Helder Tedeschi

normal upper superior limit of ADI in sagittal CT scan reconstruction should be 2 mm. This change would probably affect the sensibility and the specificity of the CT scan in detecting many diseases, such as atlanto-axial instabilities. In our series, the mean distance from the tip of the odontoid process to the line proposed by Chamberlain was −1.55 mm (below the line). Of note, some patients had the tip of the odontoid 2 mm or even 5 mm above the Chamberlain line, both levels that have been proposed as diagnostic criteria for basilar invagination. 8 , 21 Based on