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Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010

. Khalessi , MD, MPH , and Patrick C. Hsieh , MD (Los Angeles, CA) 8 2010 113 2 A423 A423 This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose. 2010 Introduction: Vertebral artery injury is a serious complication of screw-based atlantoaxial fusion. To our knowledge, violation of the vertebral artery has been described only in the setting of a screw incurred injury. We describe the first case of atlantoaxial fixation complicated by symptomatic and reversible

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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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D. Kojo Hamilton, Justin S. Smith, Charles A. Sansur, Aaron S. Dumont and Christopher I. Shaffrey

that can preclude screw placement or result in vertebral artery injury. 5 , 11 , 17 , 24 , 37 In an effort to overcome the limitations of prior techniques for C1–2 fixation, Goel et al. 13 , 14 introduced an alternative method that used plate-screw fixation of C-1 lateral mass and C-2 pars screws. Essential to the technique of Goel and colleagues was routine bilateral sectioning of the C-2 ganglion to facilitate hemostasis of the venous plexus, provide wide exposure of the atlantoaxial joint, and facilitate screw placement, and for joint decortication and

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Vincent C. Traynelis

bilateral pain after surgery. The other patients had new pain (JS Yeom et al., presentation at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 2010). In the commentary following the article by Goel et al., 2 McCormick and Kaiser also reported experiencing this complication after C-2 neurectomy. The authors are to be congratulated for carefully documenting and reporting patient outcomes following C-2 neurectomy. The data are useful for those surgeons who routinely utilize this technique during atlantoaxial arthrodesis as well as those who

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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