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Michael G. Kaiser, Praveen V. Mummaneni, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

technique in vivo for cervical application. One patient underwent a posterior atlantoaxial fusion with placement of iliac crest autograft and sublaminar wires while the second patient underwent an anterior cervical discectomy and fusion with plate stabilization. Three Vitallium beads were inserted into each VB of interest at the time of surgery. The authors performed RS at 3, 6, and 12 months postoperatively. In both cases, the authors reported that RS was more sensitive than dynamic radiography in detecting both angular and translational motion; the surgeries in both

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Timothy C. Ryken, Robert F. Heary, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Langston T. Holly, Michael G. Kaiser, Praveen V. Mummaneni, Tanvir F. Choudhri, Edward J. Vresilovic and Daniel K. Resnick

were compared: rib graft in 300 posterior cervical fusions. iliac crest graft in 300: 248 for anterior & 52 for posterior fusions. Fusion criteria included bony trabeculae traversing the donor-recipient interface & long-term stability on flexion-extension radiographs. Graft morbidity was defined as any untoward event attributable to graft harvest. Statistical comparisons by Fisher exact test. III Rib grafts: occipitocervical (196), atlantoaxial (35), subaxial (69). Iliac crest grafts: occipitocervical (28), atlantoaxial (10), subaxial (14). Fusion

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Corbett D. Winegar, James P. Lawrence, Brian C. Friel, Carmella Fernandez, Joseph Hong, Mitchell Maltenfort, Paul A. Anderson and Alexander R. Vaccaro

O ccipitocervical arthrodesis is indicated to treat instability of the occipitocervical joints and to provide biomechanical stability in the setting of trauma, degenerative disease, or tumor following decompressive surgery. The causes of occipitocervical and atlantoaxial pathology are varied and include trauma, rheumatological diseases, tumor, infection, congenital malformation, and degenerative disease processes. 2 , 3 , 40 , 45 , 47 Instability of the cervicocranium may lead to significant pathological translation, longitudinal displacement, or basilar

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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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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