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Spontaneous Dislocation of the Atlas

Report of a Case Simulating Syringomyelia with a Discussion of Etiology and Methods of Treatment

Paul Skok, John Kapp and Charles E. Troland

next day the sensory level was barely perceptible although there was still no improvement in the motor signs. By the 3rd postoperative day there was no sensory level obtainable at all. The remainder of her course was uneventful with strength noticeably returning by the 2nd postoperative week. During this time the patient was treated by rest in bed without traction. Thereafter a Zimmer brace was used to maintain the atlanto-axial articulation. It was decided that fusion would be undertaken if in the course of this conservative therapy any further dislocation

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Richard C. Schneider, Kenneth E. Livingston, A. J. E. Cave and Gilbert Hamilton

thus separated; its left transverse process was also fractured. The 3rd cervical vertebra showed fractured transverse processes and its neural arch remained ligamentously attached to that of the axis. A fracture line involved the bodies of these two vertebrae, passing between the upper aspect of the 3rd cervical body and the inferior surface of the 1st intervertebral disc which remained attached to the inferior aspect of the body of axis. The anterior and posterior longitudinal ligaments were ruptured and the posterior atlanto-axial membrane was torn. There was

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George C. Stevenson, Ronald J. Stoney, Roland K. Perkins and John E. Adams

laughter. The patient has been discharged from the hospital and is working at his previous job. Because postoperative cinefluorographic studies of the cervical spine revealed no significant instability, a planned atlanto-axial fusion was not done. Possible Application This transcervical transclival craniotomy approach may have application in the treatment of many extracerebral neoplasms situated anterior to the brain stem. 35, 45 Even if total extirpation of a lesion such as a clival or foramen magnum meningioma 5, 9, 15, 39, 53, 59 or chordoma 4, 13, 34, 36

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David G. Kline

The patient in this case presented clinical findings suggestive of a severe head injury but was found instead to have an atlanto-axial dislocation, secondary to hypoplasia of the odontoid. Case Report D.H.., a 14-year-old girl, was entirely well until May 9, 1965. On entering an automobile she had grazed her forehead on the inner roof of the car. She then fell backward so that the back of her head struck the pavement. Observers stated she was semi-responsive and appeared to be struggling to say she could not breathe. Her friends urged her to get up and go

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24 6 1002 1006 10.3171/jns.1966.24.6.1002 Acute Extradural Hematoma of the Posterior Fossa I. Z. Kosary Y. Goldhammer M. A. Lerner June 1966 24 6 1007 1012 10.3171/jns.1966.24.6.1007 Atlanto-axial Dislocation Simulating a Head Injury; Hypoplasia of the Odontoid David G. Kline June 1966 24 6 1013 1016 10.3171/jns.1966.24.6.1013 Spontaneous Spinal Epidural Hematoma During Pregnancy Jerzy Bidzinski June 1966 24 6 1017 1017 10.3171/jns.1966.24.6.1017 An Intramedullary Epidermal Inclusion Cyst of the Thoracic Cord Associated with a Previously Repaired

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' Syringal Hemorrhage Phanor Perot William Feindel Donald Lloyd-Smith October 1966 25 4 447 451 10.3171/jns.1966.25.4.0447 Cerebral Hemangioblastoma E. Rivera J. L. Chason October 1966 25 4 452 454 10.3171/jns.1966.25.4.0452 Intracranial Spread of Adamantinoma I. C. Bailey October 1966 25 4 455 457 10.3171/jns.1966.25.4.0455 Spontaneous Atlanto-Axial Dislocation in a Mongoloid Child with Spinal Cord Compression Andrievs J. Dzenitis October 1966 25 4 458 460 10.3171/jns.1966.25.4.0458 Interstitial Hypertrophic Neuritis of the Eighth Cranial Nerve B

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Andrievs J. Dzenitis

Stability of the atlanto-axial junction depends on the elasticity and length of the craniovertebral ligaments that govern mobility about the upper cervical spine, 4, 17, 27 the attitude of the articulating facets 9 and the integrity of the odontoid process. 16 Since the original description of spontaneous atlanto-axial dislocation by Bell (1830), 3 this entity has been reported following infections about the nasopharynx or neck in children, 1, 4, 17, 19, 23, 25, 27 with rheumatoid arthritis, ankylosing spondylitis, 11, 12, 16, 18, 19, 20 poliomyelitis 6

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William Beecher Scoville, Arthur H. Palmer, Khairy Samra and Gonzalo Chong

A crylic plastics have been used extensively in the repair of skull defects 10, 12 and have been tried not too successfully as replacement therapy for worn-out intervertebral discs, 2, 5 for internal fixation in fractures, and in arthritic spines. 1–4, 7–9, 11 Dott of Edinburgh 3 mentioned his use of acrylic plastic in atlanto-axial subluxation from rheumatoid arthritis, and his associate Harris 6 has written of further uses including the fixation of fractures of the cervical spine. Clinical and animal work has shown that acrylic plastic properly used

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.28.3.0262 Transoral Decompression of Atlanto-Axial Dislocation Due to Odontoid Hypoplasia Alvin D. Greenberg William B. Scoville Lycurgus M. Davey March 1968 28 3 266 269 10.3171/jns.1968.28.3.0266 Ganglioneuroblastoma of the Cerebellum F. A. Durity C. L. Dolman P. D. Moyes March 1968 28 3 270 273 10.3171/jns.1968.28.3.0270 Optic Glioma and Pituitary Adenoma in the Same Patient Frank J. Otenasek Richard J. Otenasek Jr. March 1968 28 3 274 276 10.3171/jns.1968.28.3.0274 Spontaneous Remission of an Intraventricular Hemorrhage John D. Loeser J. Timothy Stuntz William

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Alvin D. Greenberg, William B. Scoville and Lycurgus M. Davey

T he transoral approach to the upper cervical spine is not a new procedure. In 1930, German 5 demonstrated its feasibility in dogs; Crowe 12 drained several cases of tuberculous spondylitis and retropharyngeal abscesses through the mouth; Scoville 10 reported its use for removal of the odontoid process in basilar impression; Southwick and Robinson 12 and Mosberg and Lippman 7 described the transoral treatment of lesions of the second cervical vertebra; Fang and Ong 3 reported six cases of transoral reduction and fusion of atlanto-axial dislocations