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Pravin Salunke, Sanjay Behari, Markani V. Kirankumar, Manish S. Sharma, Awadesh K. Jaiswal and Vijendra K. Jain

atlantoaxial dislocation may be the result of improper segmentation of the occipital and upper cervical sclerotomes. Thus, the failure of the rostral–ventral component (that forms the margin of the foramen magnum) and the caudal–dorsal component (that forms the superior portion of the posterior arch of the atlas) of the neural arch of proatlas, and the first spinal sclerotome (that forms the inferior portion of the posterior arch of C-1), leads to occipitalization of the atlas. Segmentation defects of the second spinal sclerotome lead to C2–3 fusion. 32 Because the ventral

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Pravin Salunke, Manish Sharma, Harsimrat Bir Singh Sodhi, Kanchan K. Mukherjee and Niranjan K. Khandelwal

C ongenital atlantoaxial dislocation is associated with a variable patient age at presentation. Factors determining this variability remain obscure. The stability of a joint is largely determined by the characteristics of the facets and their relationship to each other, although there are other factors as well. The orientation of the C1–2 facets in the sagittal plane could possibly determine the anterior slippage of C-1 over C-2, whereas the orientation of these facets in the coronal plane would determine the telescoping of C-2 into C-1 (vertical slip

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Pravin Salunke, Sameer Futane, Sushant K. Sahoo, Mandeep S. Ghuman and Niranjan Khandelwal

(due to not opening and drilling the facets), lack of rigid construct, or unnecessarily including multiple adjacent segments. In addition to the preoperative diagnosis of anomalous VA, we have attempted to highlight some operative nuances to prevent its injury during CVJ surgery without compromising on the rigid C1–2 (short segment) bone fusion. Methods The study was conducted in the last 2 years. Fifteen patients with congenital atlantoaxial dislocation (AAD) were studied. Preoperative 3D CT angiograms (CTAs) were obtained in all patients. The angiograms

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Pravin Salunke, Sushanta K. Sahoo, Ramesh Doddamani, Chirag K. Ahuja and Kanchan K. Mukherjee

T raumatic atlantoaxial (C1–2) dislocation with Type II odontoid fracture is not uncommon. This usually occurs in the anteroposterior or sagittal plane. However, rotational and lateral C1–2 dislocation is rare. 5 , 9 The C1–2 facets may get locked, making the dislocation irreducible. We describe a rare case of irreducible C1–2 posterior and true lateral dislocation that was managed successfully by a direct posterior approach. The mode of injury and the method used to achieve intraoperative reduction are discussed. Case Report History and

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Pravin Salunke, Sushanta K. Sahoo, Arsikere N. Deepak, Mandeep S. Ghuman and Niranjan K. Khandelwal

T he management of atlantoaxial dislocation (AAD) is challenging due to the neural structures the craniovertebral junction (CVJ) houses and the proximity of the vertebral arteries (VAs). The dislocation may be reducible or irreducible. The reducible AAD can be defined as C1–2 alignment on extension or application of cervical traction. If the dislocation cannot be reduced despite cervical traction, it is labeled as an irreducible AAD. Management becomes difficult with irreducibility of the dislocation. Currently, the focus in treating such patients has

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Arsikere N. Deepak, Pravin Salunke, Sushanta K. Sahoo, Prashant K. Prasad and Niranjan K. Khandelwal

C ongenital atlantoaxial dislocation (AAD) is traditionally classified into irreducible or reducible. The dislocation is commonly seen in the anteroposterior plane (quantified by the atlantodental interval) or the vertical plane (defined as violation of the Chamberlain line, so-called basilar invagination [BI] Type I). 4 , 5 , 8 Often it can be a combination of the 2 planes. Reducible AAD (RAAD) is defined as C1–2 dislocation in either or both planes that reduces completely on extension or on application of traction. The failure to reduce completely

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Pravin Salunke

TO THE EDITOR: I read the recently published article by Wu et al. 10 ( Wu X, Wood KB, Gao Y, et al: Surgical strategies for the treatment of os odontoideum with atlantoaxial dislocation. J Neurosurg Spine 28:131–139, February 2018 ). The authors have described surgical strategies for treating patients with atlantoaxial dislocation (AAD) with os odontoideum. They classified patients based on reducibility of dislocation. Those with reducible AAD were treated with posterior stabilization alone, whereas those with irreducible AAD underwent transoral decompression