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John G. Piper and Arnold H. Menezes

T he management of spinal tumors has undergone tremendous evolution in the last decade. Key factors have included improved anatomical definition provided by new imaging techniques and the development of spinal instrumentation that permits radical tumor resection while maintaining spinal stability. 10, 29, 30, 34 However, because of their rarity and complex biomechanical properties, the management of craniovertebral junction tumors remains unclear. This is particularly true of the axis vertebra, in which reported surgical interventions have been limited to

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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: https://youtu.be/LjxxINmzph0

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Sui-To Wong, John Zovickian, Yongjin Hou, Chris Sonne and Dachling Pang

The authors report the first case of unilateral traumatic rupture of the C-2 neurocentral synchondrosis. A 26-month-old child was in a vehicular collision that caused his head to be rotated sharply to the left with the neck flexed. He had severe neck pain but was neurologically normal. Computerized tomography scanning showed rupture of the left C-2 neurocentral synchondrosis, a right C-2 pars interarticularis fracture, and anterior angulation of C-2 on C-3. The neck injury was unrecognized until postinjury Day 9 when an MRI study showed a tear of the posterior longitudinal ligament at C2–3 and separation of the C-2 body from the inferior anular epiphysis. A second CT showed widening of the synchondrosis fracture, increased angulation of C-2 on C-3, and distraction of the right C-2 pars fracture. The mechanism of the neurocentral synchondrosis fracture is thought to be hyperflexion-axial loading combined with leftward rotation, which provided the lateral force that overcame the cartilaginous synchondrosis and extruded the lateral mass. The patient underwent open reduction and posterior fusion of C1–3, and was maintained in a halo jacket for 4 months, when CT scans demonstrated solid C1–C3 fusion and ossification of the injured synchondrosis. Unilateral traumatic rupture of the C-2 neurocentral synchondrosis is one component of several injuries involving C-2 sustained before synchondrosis closure. The resulting C2–3 relationship is highly unstable. Reduction and C1–C3 fusion are necessary in patients with significant displacement of the adjacent bony units.

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Panya Luksanapruksa, Jacob M. Buchowski, Neill M. Wright, Frank H. Valone III, Colleen Peters and David B. Bumpass

. Postoperative radiographs ( C ) demonstrate posterior occipitocervical stabilization using an occipital plate and lateral mass screws. TABLE 1. Summary of clinical results among 15 patients with metastasis at the axis vertebra Variable Results Sex (%)  Male 10 (66.67)  Female 5 (33.33) Average age in yrs (range) 64.8 ± 11.8 (48–80) Average CCI (range) 9.73 ± 1.57 (7–12) Primary site (%)  Breast 4 (26.67)  Lung 4 (26.67)  Bladder 2 (13.33)  Myeloma 2 (13.33)  Melanoma 2 (13.33)  Renal cell carcinoma 1 (6.67) Average op time in mins (range) 215.2 ± 57.2 (120–324) Average blood

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Martin Stangenberg, Lennart Viezens, Sven O. Eicker, Malte Mohme, Klaus C. Mende and Marc Dreimann

pain and restoring stability, can easily be combined with other ventral or dorsal procedures of the cervical spine, and, in the axis vertebra, can be performed from posteriorly. Vertebroplasty of the cervical spine thus represents a minimally invasive alternative to the far more invasive vertebrectomy with vertebral body replacement and anterior spondylodesis. To perform the vertebroplasty, the posterior wall of the vertebral body should be intact to avoid potentially dangerous complications such as intraspinal leakage with a risk of high para- or tetraparesis. Apart

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Sushil Patkar

Patkar S . Anterior retropharyngeal cage distraction and fixation for basilar invagination: “the wedge technique” . Neurospine . 2019 ; 16 ( 2 ): 286 – 292 . 4 Patkar S . Anterior retropharyngeal titanium cage distraction of the atlanto-axial joints for reducing basilar invagination: a first report in the literature . Internet J Spine Surg . 2015 ; 10 ( 1 ). 5 Menon KV , Raniga SB . Trabecular anatomy of the axis vertebra: a study of shaded volume-rendered computed tomography images . World Neurosurg . 2018 ; 110 : 526 – 532 . e10 . 6 Menon VK

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Sushil Patkar

Transcript 0:20 Introduction. Atlantoaxial dislocation is a challenging problem. C1 lateral mass with C2 pars–pedicle plate–rod fixation is the current standard of care. Avoiding vertebral artery injury and correction of the deformity are the two main concerns which need attention. Recent literature has focused on the use of intraoperative navigation, O-arm, and 3D printing to enhance safety, but these come at an increased cost (Goel and Laheri, 1994; Harms and Melcher, 2001). Review of the axis vertebra anatomy consistently shows the presence of dense compact

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Motoo Kubota, Naokatsu Saeki, Akira Yamaura, Yoshiaki Yamamoto, Yuko Nemoto and Toshio Fukutake

, 1978 Charlton OP, Gehweiler JA, Morgan CL, et al: Spondylolysis and spondylolisthesis of the cervical spine. Skeletal Radiol 3: 79–84, 1978 2. Currarino G : Primary spondylosis of the axis vertebra (C2) in three children, including one with pyknodysostosis. Pediatr Radiol 19 : 535 – 538 , 1989 Currarino G: Primary spondylosis of the axis vertebra (C2) in three children, including one with pyknodysostosis. Pediatr Radiol 19: 535–538, 1989 3. Fardon DF , Fielding JW : Defects of the pedicle and

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Oren N. Gottfried, Scott L. Parker, Ibrahim Omeis, Ali Bydon, Ziya L. Gokaslan and Jean-Paul Wolinsky

4 Currarino G : Primary spondylolysis of the axis vertebra (C2) in three children, including one with pyknodysostosis . Pediatr Radiol 19 : 535 – 538 , 1989 5 Fardon DF , Fielding JW : Defects of the pedicle and spondylolisthesis of the second cervical vertebra . J Bone Joint Surg Br 63 : 526 – 528 , 1981 6 Fessy MH , Durand JM , Gunepin FX , Chavane H , Béjui JB , Bouchet A : [An unusual anomaly: cervical spondylolysis in an adult.] . Rev Chir Orthop Reparatrice Appar Mot 85 : 174 – 177 , 1999 . (Fr) 7 Forsberg DA

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Loyola V. Gressot, Sudhakar Vadivelu, Steven W. Hwang, Daniel H. Fulkerson, Thomas G. Luerssen and Andrew Jea

, 2006 2 Archer E , Batniztky S , Franken EA , Muller J , Hale B : Congenital dysplasia of C2–6 . Pediatr Radiol 6 : 121 – 122 , 1977 3 Bono CM , Vaccaro AR , Fehlings M , Fisher C , Dvorak M , Ludwig S , : Measurement techniques for upper cervical spine injuries: consensus statement of the Spine Trauma Study Group . Spine (Phila Pa 1976) 32 : 593 – 600 , 2007 4 Currarino G : Primary spondylolysis of the axis vertebra (C2) in three children, including one with pyknodysostosis . Pediatr Radiol 19 : 535 – 538 , 1989