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Daniel May, Benoît Jenny and Antonio Faundez

✓ The authors report the case of a 66-year-old man with progressive, nontraumatic, C-1 cord compression who presented with a complete but hypoplastic atlas. They review six cases found in the literature. Symptoms usually develop in the late adulthood; the sagittal diameter of the canal measures 10 mm or less. The treatment requires a posterior decompression. Opening of the dura is sometimes necessary. There is no pressing need for a primary stabilization device.

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Antonio A. Faundez and Jean Charles Le Huec

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Avraam Ploumis, Chunhui Wu, Amir Mehbod, Gustav Fischer, Antonio Faundez, Wentien Wu and Ensor Transfeldt


Transforaminal lumbar interbody fusion (TLIF) is a popular fusion technique for treating chronic low-back pain. In cases of interbody nonfusion, revision techniques for TLIF include anterior lumbar interbody fusion (ALIF) approaches. Biomechanical data of the revision techniques are not available. The purpose of this study was to compare the immediate construct stability, in terms of range of motion (ROM) and neutral zone (NZ), of a revision ALIF procedure for an unsuccessful TLIF. An in vitro biomechanical comparison of TLIF and its ALIF revision procedure was conducted on cadaveric nonosteoporotic human spine segments.


Twelve cadaveric lumbar motion segments with normal bone mineral density were loaded in unconstrained axial torsion, lateral bending, and flexion-extension under 0.05 Hz and ± 6-nm sinusoidal waveform. The specimens underwent TLIF (with posterior pedicle fixation) and anterior ALIF (with intact posterior fixation). Multidirectional flexibility testing was conducted following each step. The ROM and NZ data were measured and calculated for each test.


Globally, the TLIF and revision ALIF procedures significantly reduced ROM and NZ compared with that of the intact condition. The revision ALIF procedures achieved similar ROM as the TLIF procedure.


Revision ALIF maintained biomechanical stability of TLIF in nonosteoporotic spines. Revision ALIF can be performed without sacrificing spinal stability in cases of intact posterior instrumentation.