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Joe M. McWhorter, Eben Alexander Jr., Courtland H. Davis Jr. and David L. Kelly Jr.

apparent neurological or x-ray abnormalities. A soft cervical collar was applied. She continued to complain of neck pain, and cervical spine films 6 weeks after her accident showed subluxation of C-2 on C-3 ( Fig. 1 upper left ). She still had no neurological deficit. A posterior cervical fusion of C1–4 was done with rib grafts. Postoperative spine films showed satisfactory alignment of C-2 on C-3. She wore a four-poster brace for the next 4 months. She has been followed routinely for 13 years and at last examination had no limitation of neck movement and no

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Trans-unco-discal approach

A combined anterior and lateral approach to cervical discs

Akira Hakuba

transdiscal approach. We have not hesitated to remove extensive posterior spurs even in cases of severe compressive myelopathy with nearly complete myelographic block. Extensive removal of the posterolateral corner and transverse ridge of the vertebral body allows sufficient space for the nerve roots and spinal cord, and there is little danger of encroachment of the intervertebral foramen and spinal canal, even if, without interbody bone graft, slight forward subluxation of the lower vertebral body takes place. With these precautions, interbody bone graft is considered to

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Anthony J. Raimondi, Francisco A. Gutierrez and Concezio Di Rocco

M ultiple level laminectomies are a currently accepted surgical approach to spinal cord lesions. In most adult patients the procedure is not followed by evident impairment of spine stability. 7 In children, however, multiple level laminectomies may cause kyphosis, anterior subluxation, and instability of the cervical 1 or thoracic and lumbar 10 spine. Several structures provide for the stability of the spinal column: intervertebral joints, laminae, ligamentum flavae, spinous processes, interspinous and supraspinous ligaments, and paraspinal muscles. 1, 2

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José Barberá, Jaime Broseta, Francisco Argüelles and Juan L. Barcia-Salorio

, lt none none unchanged, 6 wks Eisenberg, et al. , 1972 33, M rt hip subluxation; fracture posterior acetabulum sciatic traction paralysis of peroneal and posttibial nerves; sensory loss in rt foot, and lateral region of leg L5-S1 meningocele, rt none S-1 exploration: S-1 nerve root partially lesioned pain, rhizotomy & cordotomy, amputation below knee, 6 yrs McLennan, et al. , 1973 17, F fracture lt inferior pubic ramus, sacroiliac joint & pubic symphysis radicular traction

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Peter Dyck and John B. Doyle Jr.

patient crouched over the handlebars (C) the pain subsided and the myelographic block was completely relieved (F). Slight subluxation was produced. The electromyogram was normal and spinal fluid protein was 60 mg%. X-ray films revealed lumbar spondylosis with particularly prominent spur formation at the fourth intervertebral level. Myelography was performed with the patient assuming the various postures described above to correlate the symptoms with the myelographic abnormality. Operation . Since the pain pattern was most reminiscent of a fifth lumbar

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Alan H. Fruin and Thomas P. Pirotte

accomplished. 13 The exact mechanism of injury in this case is uncertain, but previous case reports have indicated hyperextension as a probable cause of the subluxation. 4, 6, 9 It is likely that violent hyperextension tears the tectorial membrane allowing dislocation to occur. In three of the previous cases, cranial nerve palsies have been reported; evidence of a cord lesion has been present in two ( Table 1 ). In our case, there was evidence of bilateral sixth, ninth, tenth, eleventh, and twelfth cranial nerve injuries and mild spinal cord injury. Schneider and Johnson

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Michael E. Carey, Francis C. Nance, Homer D. Kirgis, Harold F. Young, Lloyd C. Megison Jr. and David G. Kline

amylase had fallen to 160 SU, and 2 weeks later it was 138 SU. He was eventually discharged to a rehabilitation facility. Case 5 On October 2, 1975, this 23-year-old man became quadriplegic while wrestling. He was admitted to Charity Hospital, New Orleans, Louisiana. He revealed that he used alcohol sparingly. Neurological examination showed a complete motor and sensory level at C5–6. The abdomen was soft. A C5–6 subluxation was present on x-ray film. The patient was placed in tongs; dexamethasone, an anti-cholinergic, and codeine were started. On October 6, the

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Acute fractures of the odontoid process

An analysis of 45 cases

Michael L. J. Apuzzo, James S. Heiden, Martin H. Weiss, Truman T. Ackerson, J. Paul Harvey and Theodore Kurze

: Fractures and subluxations of the atlas and axis. A follow-up study of 20 patients. Acta Orthop Scand 42 : 251 – 258 , 1971 Hentzer L, Schalimtzek M: Fractures and subluxations of the atlas and axis. A follow-up study of 20 patients. Acta Orthop Scand 42: 251–258, 1971 21. Herrmann HD : Metal plate fixation after anterior fusion of unstable fracture dislocations of the cervical spine. Acta Neurochir 32 : 101 – 111 , 1975 Herrmann HD: Metal plate fixation after anterior fusion of unstable fracture dislocations of the

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methacrylate spinal fusion. Its use in spontaneous atlantoaxial subluxation in children. Egypt Orthop J 4 : 11 – 16 , 1969 Alsharif H: Methyl methacrylate spinal fusion. Its use in spontaneous atlantoaxial subluxation in children. Egypt Orthop J 4: 11–16, 1969

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Franklin C. Wagner Jr., John C. VanGilder and George J. Dohrmann

-Barrera, phosphotungstic acid hematoxylin, and Holzer stains. X-ray films of the spinal column were obtained before perfusion in each animal to control for possible vertebral subluxation as a secondary cause of trauma. Results Four Hours After Injury The most striking feature of the sections from animals 4 hours after injury was the hemorrhage in the central gray matter ( Table 1 ). The amount of hemorrhage observed varied directly with the magnitude of the original trauma, with more hemorrhage being seen in those animals in whom the initial trauma was greater. TABLE