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Marcus D. Mazur, Michael L. Mumert, Erica F. Bisson and Meic H. Schmidt

favorable. For example, injury to the C1–2 joints and intraarticular fractures may cause painful posttraumatic arthrosis, and the presence of an unstable Jefferson fracture would result in persistent C1–2 subluxation. 31 In these cases, posterior C1–2 fusion is preferable to anterior screw fixation. Chronic Nonunion Immediate fixation of odontoid fractures provides the best chance of fracture healing. Nevertheless, nonunion of odontoid fractures is a relatively common complication in patients treated nonsurgically and those in whom the diagnosis was delayed. Many

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, reduced ROM, >2 level ACDF, ligamentous injuries >3.5mm subluxation or >11° of angulation, burst fractures with retropulsion, lateral mass fractures with incongruity, delayed cervical instability, junction spanning instrumentation. Patients who are pain free, without neurologic deficit, have full ROM, radiologic evidence of a healed axis lateral mass fractures, odontoid fractures, non-displaced Jefferson fractures, <2 level ACDF, single level corpectomies, compression fractures, fractures without retropulsion, chronic discs, fully fused, asymptomatic, non

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Marcus D. Mazur, Walavan Sivakumar, Jay Riva-Cambrin, Jaes Jones and Douglas L. Brockmeyer

/graft revised after 6 wks of antibiotics 8 5.7, F skeletal dysplasia (SED) no Oc–C2, bilat pars screws immediate hardware failure; C-2 pars screw malpositioned 9a 2.0, F trauma no Oc–C2, bilat pars screws immediate hardware failure; after 1st op, C-2 screw malpositioned & persistent C1–2 subluxation 9b 2.2, F trauma no Oc–C2, bilat pars screws wound infection after 2nd op requiring washout; 4 mos later developed graft resorption requiring revision 10 3.8, F Down syndrome no Oc–C2, unilat pars screw graft failure

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Vijay M. Ravindra, Jayson A. Neil, Marcus D. Mazur, Min S. Park, William T. Couldwell and Philipp Taussky

-pathological study . . Brain 79 : 319 – 331 , 1956 19 Kawaguchi T , Fujita S , Hosoda K , Shibata Y , Iwakura M , Ta-maki N : Rotational occlusion of the vertebral artery caused by transverse process hyperrotation and unilateral apophyseal joint subluxation. Case report . J Neurosurg 86 : 1031 – 1035 , 1997 20 Kojima N , Tamaki N , Fujita K , Matsumoto S : Vertebral artery occlusion at the narrowed “scalenovertebral angle”: mechanical vertebral occlusion in the distal first portion . Neurosurgery 16 : 672 – 674 , 1985 21 Kuether TA

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Marcus D. Mazur, Vijay M. Ravindra and Douglas L. Brockmeyer

instability was determined by identifying abnormal motion on flexion-extension radiographs and reviewing CT scans with 2D sagittal and coronal reconstructions. Previously described criteria were used to define the presence of OC subluxation, Oc–C1 lateral displacement, or C1–2 lateral displacement. 4 Bony fusion was defined as a solid bony bridge from the occiput to the posterior elements of C-2 on postoperative CT scans. The presence of partial bony bridging between the graft material and the occiput and C-2, but without a clear gap between the graft-bone interfaces, was