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Eric Zimmerman, John Grant, W. Michael Vise, David Yashon and William E. Hunt

achieved when the halo device was used in the treatment of two patients with bursting fractures of the atlas vertebra. Case Reports Case 1 This 52-year-old school principal tripped during a basketball game, striking the vertex of his skull against a cement wall. He did not lose consciousness, but had immediate severe occipital pain and limitation of neck motion. Examination . Musculoskeletal examination revealed marked tenderness and restricted motion of the neck, especially in rotation. Neurological examination was normal. Cervical spine films showed only a

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Jefferson fracture of the atlas

Report of six cases

Sang Y. Han, David M. Witten and John P. Mussleman

: Examination of the atlanto-axial joint following injury. With particular emphasis on rotational subluxation. Am J Roentgenol Radium Ther Nucl Med 76: 1081–1094, 1956 4. Jefferson G : Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. Br J Surg 7 : 407 – 422 , 1920 Jefferson G: Fracture of the atlas vertebra. Report of four cases, and a review of those previously recorded. Br J Surg 7: 407–422, 1920 5. Shapiro R , Youngberg AS , Rothman SLG : The

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Atul Goel

The basic surgical steps in the Goel technique of atlantoaxial fixation involve exposure of the atlantoaxial articulation, denuding of the articular cartilage, stuffing of bone graft pieces within the articular cavity, and subsequent instrumentation.

“High-riding” vertebral artery in relationship to the pedicle-facet of C2 has been widely recognized to be a factor that makes insertion of the C2 pedicle-facet screw difficult or impossible. In this video, a technique of exposure and mobilization of the high-riding vertebral artery to permit safe C2 screw insertion is shown. An alternative option in the presence of such a high-riding vertebral artery is to use either C2 laminar or inferior facetal screw insertion.

The video can be found here:

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Mikinobu Takeuchi, Norimitsu Wakao, Mitsuhiro Kamiya, Aichi Niwa, Koji Osuka and Masakazu Takayasu

upper cervical lesions. In the case described here, we encountered a novel case of OPLL below the axial vertebra (C-2) in a kyphotic cervical spine, with an atlas vertebra (C-1) posterior arch that compressed the spinal cord and caused nonspecific myelopathy. We describe the nonspecific myelopathy and pathognomonic protruded-head position causing this symptom. The morphological findings between the OPLL in the kyphotic cervical spine, the hyperlordotic C-1 verterbra, and protruded-head position are also discussed. Case Report History and Examination A

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Arthur E. Marlin, Gayle R. Williams and J. Fletcher Lee

osteochondral fracture. Jefferson fractures are frequently defined as separation of the lateral masses secondary to disruption, anteriorly and posteriorly, of the bone ring. In fact, however, Jefferson described all fractures of the atlas vertebra. Both the anterior and posterior arch were fractured in only 10 of his cases. The posterior arch alone was fractured in 15, the anterior alone in six. The lateral masses alone were the site of fracture in five, and the lateral masses and the posterior arch in two. 3 The cases reported here thus comply with the criteria of

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Maurizio Domenicucci, Demo Eugenio Dugoni, Cristina Mancarella, Alessandro D'Elia and Paolo Missori

C urrently , there is no well-defined, widely recognized classification for fractures of the atlas. In the literature, most works that report on fractures of C-1 cite the classic work of Sir Geoffrey Jefferson (1886–1961) of 1920, titled “Fracture of the atlas vertebra: report of four cases, and a review of those previously recorded.” 6 Based on this work, and the successive paper published in 1927 by the same author, 7 most authors attribute the classification of 5 types of atlas fractures to Jefferson. 5 , 12 Some authors also refer to a “Jefferson

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Nicholas AuYong and Joseph Piatt Jr.

reason to use a cervical orthosis for any purpose other than relief of symptoms. Disclaimer The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. References 1 Abuamara S , Dacher JN , Lechevallier J : Posterior arch bifocal fracture of the atlas vertebra: a variant of Jefferson fracture . J Pediatr Orthop B 10 : 201 – 204 , 2001 2 Avellino AM , Mann FA , Grady MS , Chapman JR , Ellenbogen RG , Alden TD , : The misdiagnosis of acute cervical

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Brian A. O'Shaughnessy, Sean A. Salehi, Saad Ali and John C. Liu

. Philadelphia : Lippincott Williams & Wilkins , 2003 , Vol 1 , pp 945 – 959 Ellenbogen RG: Chiari I malformation, in Batjer HH, Loftus CM (eds): Textbook of Neurological Surgery: Principles and Practices. Philadelphia: Lippincott Williams & Wilkins, 2003, Vol 1, pp 945–959 7. Fowler JL , Sandhu A , Fraser RD : A review of fractures of the atlas vertebra. J Spinal Disord 3 : 19 – 24 , 1990 Fowler JL, Sandhu A, Fraser RD: A review of fractures of the atlas vertebra. J Spinal Disord 3: 19–24, 1990 8

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Marcelo D. Vilela, Richard J. Bransford, Carlo Bellabarba and Richard G. Ellenbogen

on 40 human atlas specimens . Spine (Phila Pa 1976) 33 : 766 – 770 , 2008 5 Gehweiler JA , Duff DE , Martinez S , Miller MD , Clark WM : Fractures of the atlas vertebra . Skeletal Radiol 1 : 97 – 102 , 1976 6 Hadley MN , Dickman CA , Browner CM , Sonntag VK : Acute traumatic atlas fractures: management and long term outcome . Neurosurgery 23 : 31 – 35 , 1988 7 Harris JH Jr , Carson GC , Wagner LK : Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on

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Daniel May, Benoît Jenny and Antonio Faundez

51: 362–367, 1979 4. Gehweiler J , Daffner R , Roberts LJ : Malformations of the atlas vertebra simulating the Jefferson fracture. AJR 149 : 1083 – 1086 , 1983 Gehweiler J, Daffner R, Roberts LJ: Malformations of the atlas vertebra simulating the Jefferson fracture. AJR 149: 1083–1086, 1983 5. Geipel P : Zur Kenntnis der Spaltbildung des Atlas und Epistropheus. Fortschr Röntgenstr 52 : 533 – 570 , 1935 Geipel P: Zur Kenntnis der Spaltbildung des Atlas und Epistropheus. Fortschr