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Christopher P. Ames, Vincent Y. Wang, Vedat Deviren and Frank D. Vrionis

, epidural decompression, and circumferential fusion of spinal metastases . Spine 25 : 2240 – 2250 , 2000 4 Bilsky MH , Shannon FJ , Sheppard S , Prabhu V , Boland PJ : Diagnosis and management of a metastatic tumor in the atlantoaxial spine . Spine 27 : 1062 – 1069 , 2002 5 Cahill DW , Kumar R : Palliative subtotal vertebrectomy with anterior and posterior reconstruction via a single posterior approach . J Neurosurg 90 : 42 – 47 , 1999 6 Cole JS , Patchell RA : Metastatic epidural spinal cord compression . Lancet Neurol 7

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Justin K. Scheer, Jessica Tang, Johnny Eguizabal, Azadeh Farin, Jenni M. Buckley, Vedat Deviren, R. Trigg McClellan and Christopher P. Ames

, Prabhu V , Boland PJ : Diagnosis and management of a metastatic tumor in the atlantoaxial spine . Spine 27 : 1062 – 1069 , 2002 5 Boriani S , Bandiera S , Biagini R , Bacchini P , Boriani L , Cappuccio M , : Chordoma of the mobile spine: fifty years of experience . Spine 31 : 493 – 503 , 2006 6 Boriani S , Chevalley F , Weinstein JN , Biagini R , Campanacci L , De Iure F , : Chordoma of the spine above the sacrum. Treatment and outcome in 21 cases . Spine 21 : 1569 – 1577 , 1996 7 Chou D , Acosta F Jr

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Jon Park, Justin K. Scheer, T. Jesse Lim, Vedat Deviren and Christopher P. Ames

T he atlantoaxial complex may become unstable due to congenital disease, an inflammatory disorder, trauma, or a neoplasm. 2 , 7 The instability can be surgically corrected with various options such as C1–2 transarticular screw fixation, wiring techniques, laminar hooks, and screw/rod constructs that require translaminar, pars, lateral mass, and pedicle screws. 33 Stabilization of the atlantoaxial complex is clinically challenging because of the high multiaxial ROM at this joint and the proximity of the vertebral artery. 22 , 25 , 26 , 35 Traditionally

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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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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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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

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Cecilia L. Dalle Ore, Christopher P. Ames, Vedat Deviren and Darryl Lau

such as atlantoaxial subluxation, cranial settling, and subaxial subluxation. 12 Lumbar involvement in RA is less well characterized; however, prior imaging-based studies have found that a majority of patients with RA also have lumbar spine abnormalities. 14 Historically, the literature has predominantly reported outcomes and complications regarding cervical spine surgery in RA patients. 29 Series of lumbar surgical outcomes in RA patients suggest an elevated incidence of complications in patients with RA compared to similar interventions in patients without RA, 5