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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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Jerry Y. Du, Alexander Aichmair, Janina Kueper, Timothy Wright and Darren R. Lebl

T he atlantoaxial joint has complex biomechanical properties as a result of its unique anatomy, which provides high levels of mobility. The absence of an intervertebral disc between the C-1 and C-2 vertebrae and associated anatomy is unique, with stability provided largely by the transverse, alar, and apical ligaments in association with the joints' articular and osseous structures. 31 , 33 A variety of degenerative conditions, previous cervical surgery, congenital anomalies, and trauma may result in atlantoaxial instability. The techniques for fixation

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Andrew Jea

SR , Fjeld-Olenec K : Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis . J Neurosurg Pediatr 2 : 42 – 49 , 2008 3 Godil SS , Parker SL , Zuckerman SL , Mendenhall SK , Mc-Girt MJ : Accurately measuring outcomes after surgery for adult Chiari I malformation: determining the most valid and responsive instruments . Neurosurgery 72 : 820 – 827 , 2013 4 Goel A : Is atlantoaxial instability the cause of Chiari

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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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Atul Goel

some special trick that he or she finds unique and superior. The very fact that no definite treatment strategy has convincingly found universal acceptance or has produced uniformly gratifying results suggests that the pathogenesis and pathophysiology of the disease process are still unclear and, to say the least, riddled with controversies and opinions. Here, the management of CM associated with or without basilar invagination and with or without syringomyelia is evaluated. All patients were treated primarily with atlantoaxial fixation. The surgical strategy was

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Francesco Costa, Alessandro Ortolina, Luca Attuati, Andrea Cardia, Massimo Tomei, Marco Riva, Luca Balzarini and Maurizio Fornari

in acute spinal trauma . Clin Orthop Relat Res 189 65 – 76 , 1984 7 Dickman CA , Sonntag VKH , Papadopoulos SM , Hadley MN : The interspinous method of posterior atlantoaxial arthrodesis . J Neurosurg 74 : 190 – 198 , 1991 8 Finn MA , Apfelbaum RI : Atlantoaxial transarticular screw fixation: update on technique and outcomes in 269 patients . Neurosurgery 66 : 3 Suppl 184 – 192 , 2010 9 Goel A , Desai KI , Muzumdar DP : Atlantoaxial fixation using plate and screw method: a report of 160 treated patients . Neurosurgery

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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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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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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