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Kalil G. Abdullah, Amy S. Nowacki, Michael P. Steinmetz, Jeffrey C. Wang, and Thomas E. Mroz

P osterior placement of lateral mass screws is a well-established and routine technique used in the fusion and stabilization of the subaxial cervical spine. 8 , 9 , 13 , 24 Established surgical techniques and their related spinal biomechanics have been well described, as have appropriate screw lengths for the subaxial cervical spine. 5 , 7 , 11 , 19 , 21 , 26 , 27 , 29 However, the majority of these studies focus on lateral mass screw placement at levels C-3 through C-6. This may be due to the belief that the C-7 lateral mass is difficult or impossible to

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Shinichi Inoue, Tokuhide Moriyama, Toshiya Tachibana, Fumiaki Okada, Keishi Maruo, Yutaka Horinouchi, and Shinichi Yoshiya

T he lateral mass screw fixation technique is commonly used for fixation of an unstable cervical spine caused by trauma, degenerative disorders, neoplasms, rheumatoid arthritis (RA), and destructive spondyloarthropathy (DSA). 2–4 , 12 , 13 , 23 This technique was first described by Roy-Camille et al. in the 1960s. 23 In that report, lateral mass screws were used with plates as a component of an internal fixation system for cervical spine arthrodesis. Following this, application of lateral mass screw fixation has been broadened by Anderson, An, and

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George Al-Shamy, Jacob Cherian, Javier A. Mata, Akash J. Patel, Steven W. Hwang, and Andrew Jea

R oy -C amille 12–14 first described the use of lateral mass screw fixation for cervical spine stabilization. Roy-Camille, Magerl, and Louis 9 , 10 , 13 popularized this safe and efficacious way of achieving rigid cervical fixation. The lateral mass is a pillar of bone that offers safe purchase for screw fixation in the pediatric cervical spine that is otherwise not suitable for other types of fixation, such as pedicle screws. 8 Complications related to screw malposition are usually due to the close proximity of exiting cervical nerve roots and the

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Bayard Wilson, Erik Curtis, Brian Hirshman, Ahmet Oygar, Karen Chen, Brandon C. Gabel, Florin Vaida, David W. Allison, and Joseph D. Ciacci

G iven the proximity of vital neural and vascular elements to cervical pedicles, 11 spine surgeons typically target the cervical lateral mass for screw fixation in patients requiring fusion. Despite this operative distinction in the cervical spine, concerns still remain regarding improper screw placement of cervical lateral mass screws. 2 , 9 Intraoperative current threshold testing for stimulus-evoked electromyographic responses may serve as a useful tool in this context. Although it remains controversial in the thoracic spine, 6 , 15 , 17 substantial

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Vincent Y. Wang, Vedat Deviren, and Christopher P. Ames

of proper instrumentation for C-1 reconstruction. In this report, we present a case of a C-1 ABC in a child who underwent resection of the lesion and reconstruction of the lateral mass with a titanium mesh cage. Case Report History and Examination This 12-year-old girl presented to our institution with a 2-month history of progressively worsening neck pain. The pain was severe enough that she was unable to sit upright without supporting her head with her hand. She had no history of trauma. On examination, she had a normal neurological examination

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Pranay Soni, Jeremy G. Loss, Callan M. Gillespie, Robb W. Colbrunn, Richard Schlenk, Michael P. Steinmetz, Pablo F. Recinos, Edward C. Benzel, and Varun R. Kshettry

and transverse ligament requires posterior fixation and fusion. Endoscopic endonasal approaches also require a skilled multidisciplinary team, which may not be readily available at all spine centers. The direct lateral approach (also known as the far lateral transatlas, extreme lateral transatlas, or anterolateral approach) involves C1 hemilaminectomy and partial or complete lateral mass resection and has been proposed as one alternative. 11 , 12 Although some ventral atlantoaxial pathologies are the result of chronic instability and require fusion for definitive

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Pranay Soni, Jeremy G. Loss, Callan M. Gillespie, Robb W. Colbrunn, Richard Schlenk, Michael P. Steinmetz, Pablo F. Recinos, Edward C. Benzel, and Varun R. Kshettry

and transverse ligament requires posterior fixation and fusion. Endoscopic endonasal approaches also require a skilled multidisciplinary team, which may not be readily available at all spine centers. The direct lateral approach (also known as the far lateral transatlas, extreme lateral transatlas, or anterolateral approach) involves C1 hemilaminectomy and partial or complete lateral mass resection and has been proposed as one alternative. 11 , 12 Although some ventral atlantoaxial pathologies are the result of chronic instability and require fusion for definitive

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Atul Goel, Vivek Bonde, and Ram Menon

V arious bone and soft-tissue anomalies have been associated with craniovertebral region anomalies. We report four cases in which we documented unilateral hypertrophy of the C-1 lateral mass that resulted in symptomatic cord compression. In a search of the literature we found no mention of a similar case. Case Reports Histories and Examinations. The clinical and demographic data obtained in the four patients are summarized in Table 1 . The patients were treated in the neurosurgery department of King Edward Memorial Hospital between 1992 and

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Monir Tabbosha, Justin Dowdy, and T. Glenn Pait

progressively widening right-sided lateral mass fracture of C-1 that was initially treated with a rigid cervical collar. Illustrative Case History and Presentation The patient, a 28-year-old healthy male without any significant medical or surgical history, was admitted after experiencing a traumatic event in which a large tree branch fell onto his posterior head and neck area while he was cutting timber. On admission, the patient was awake and alert, with full strength and sensation throughout his extremities and normal deep tendon reflexes. He did report neck and

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Cédric Barrey, Patrick Mertens, Claude Rumelhart, François Cotton, Jérôme Jund, and Gilles Perrin

P osterior cervical plate—augmented lateral mass fixation is currently used to achieve posterior internal fixation of the lower cervical spine. 19, 24, 32, 33, 35 This cervical posterior fixation device has been proven to restore the stability of the cervical motion segment after traumatic or postlaminectomy injuries. 3, 4, 8, 21, 30, 31, 34 Since Roy-Camille, et al., 27 first described the technique in 1972, many authors have discussed technical variations by which to improve its mechanical competence 2, 6, 22 or anatomical safety. 36 According to the