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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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Peng-Yuan Chang, Jau-Ching Wu, Wen-Cheng Huang, Tsung-Hsi Tu and Henrich Cheng

T o T he E ditor : We read with great interest the article by Dr. Suh and colleagues 7 (Suh BG, Padua MRA, Riew KD, et al: A new technique for reduction of atlantoaxial subluxation using a simple tool during posterior segmental screw fixation. Clinical article. J Neurosurg Spine 19: 160–166, August 2013). They introduced a novel technique using a T-shaped rod tool to facilitate reduction after the placement of screws in C-1 and C-2. We found their surgical pearl of substantial value in practical use. However, a few questions need answering before the

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Yu-Shu Yen, Peng-Yuan Chang, Wen-Cheng Huang, Jau-Ching Wu, Muh-Lii Liang, Tsung-Hsi Tu and Henrich Cheng

A lthough transoral odontoidectomy has been accepted as the treatment of choice in the surgical management of basilar invagination, 10 , 21–23 , 25 , 33 alternative approaches are emerging, including the reduction of atlantoaxial subluxation from posterior 8 , 9 , 27 , 32 and endoscopic approaches for decompression at the ventral cervicomedullary junction. 4 , 19 , 29 , 36 , 37 The feasibility of endoscopic transnasal odontoidectomy (ETO) has been demonstrated in cadaveric studies. 1 , 24 In the past several years, there also have been case reports of

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Peng-Yuan Chang, Yu-Shu Yen, Jau-Ching Wu, Hsuan-Kan Chang, Li-Yu Fay, Tsung-Hsi Tu, Ching-Lan Wu, Wen-Cheng Huang and Henrich Cheng

. Ann R Coll Surg Engl 67 : 321 – 325 , 1985 8 Crockard HA : Transoral surgery: some lessons learned . Br J Neurosurg 9 : 283 – 293 , 1995 9 Crockard HA , Calder I , Ransford AO : One-stage transoral decompression and posterior fixation in rheumatoid atlantoaxial subluxation . J Bone Joint Surg Br 72 : 682 – 685 , 1990 10 Crockard HA , Pozo JL , Ransford AO , Stevens JM , Kendall BE , Essigman WK : Transoral decompression and posterior fusion for rheumatoid atlantoaxial subluxation . J Bone Joint Surg Br 68 : 350 – 356

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Chih-Chang Chang, Wen-Cheng Huang, Tsung-Hsi Tu, Peng-Yuan Chang, Li-Yu Fay, Jau-Ching Wu and Henrich Cheng

T echniques for atlantoaxial (AA) fixation have evolved tremendously in the past several decades. Laminar wiring and clamps have become less frequently used due to high rates of nonunion or persistent instability. Since 1979, when Magerl introduced the transarticular screw (TAS), 11 the fusion rates of AA fixation have remarkably improved. However, a successful TAS fixation required adequate bone purchase of both C1 and C2 vertebrae along a steep trajectory, which usually needed reduction of the AA subluxation and was critically dependent on the width of the C2