recently undergone CyberKnife radiosurgery for a C-2 metastasis. He presented with increasing neck pain, dysphagia, inability to hold his head in an upright position, hoarseness, exotropia, and right-sided Horner syndrome. In addition to the tumor MR imaging revealed an occlusion of the right VA due to either the tumor, radiation, or both ( Fig. 1A ). There was evidence of a lateral medullary (Wallenberg) stroke. There was evidence of C1–2 subluxation, cord compression, and spinal instability. The patient underwent a C-2 laminectomy, bilateral transpedicular approach at

similar advantages in addition to their utility as a vertical reduction tool. In cases of basilar invagination due to erosion of the C1–2 joint, the placement of cages in this region restores the normal vertical alignment of the C1–2 complex and reduces the vertical deformity. In our experience 2 and that of Goel, 8 , 13 erosion of the entire C-1 lateral mass such that the condyle “sits” on C-2 is extremely rare. This technique should only be potentially applied in cases of vertical and multiaxial subluxation due to C1–2 joint erosion and in cases of significant

, the lack of any significant intraoperative or neurological complications suggests that the cervicothoracic PSO is a safe procedure. Although our series is relatively small, authors of other papers on cervical extension osteotomy have reported complications that include neurological deficits, sudden subluxation, and even death. 15 , 16 , 18 , 27 , 32 Daubs et al. 13 found that increasing age was a significant factor in predicting a complication for patients over the age of 60; however, in the present study, 8 of 11 patients were over the age of 60 years and there

DT group and 9.1% (2 patients) in the PT group (p = 1.000). However, the types of PJK were different between the groups, comparing the incidence of compression fracture and subluxation (p = 0.014). In the DT group, compression fracture of the UIV (9 patients) or UIV-1/UIV-2 (7 patients) was the most common type of PJK. In the PT group, subluxation with anterolisthesis of the proximal vertebra on the UIV was the most common mechanism of PJK. History of prior surgery was not different in the 2 groups. However, within each group, history of prior surgery was more

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

study, the rate of new neurological deficits drops dramatically after the 3- to 5-year time point. When performing 3CO, the neurological compilations encountered are secondary to direct injury, inadequate decompression, or overcorrection with closure of the osteotomy site. The prevention of neurological deficits in thoracolumbar 3CO procedures involves technical aspects such as ensuring that there is adequate release/decompression of superior and inferior nerve roots and preventing subluxation, dorsal impingement, and significant dural buckling. 8 Avoiding such