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Marco Túlio Reis, Eric W. Nottmeier, Phillip M. Reyes, Seungwon Baek and Neil R. Crawford

T he stabilization of the atlantoaxial complex is a challenge for spinal surgeons because of its proximity to neurovascular structures, 25 the small size of the bony elements, the wide ROM, its responsibility for 50% of the rotation of the cervical spine, 34 and its limited biomechanical strength. Several stabilization techniques, including the use of wire, claws, hooks, and screws, have been described. Each technique has advantages and disadvantages in terms of fusion rate, biomechanical stability, and clinical outcomes. 32 Biomechanical and clinical

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Kyle M. Fargen, Richard C. E. Anderson, David H. Harter, Peter D. Angevine, Valerie C. Coon, Douglas L. Brockmeyer and David W. Pincus

O ccipitocervical stabilization is performed in both adults and children for disorders of the atlantooccipital or atlantoaxial spine as well as those with unstable high cervical traumatic injuries. Occipitocervical fixation is the treatment of choice for craniocervical instability that is symptomatic or threatens neurological function. In children, the most common distal fixation level with modern techniques is C-2. 1 , 3 , 6 , 7 These patients maintain a significant amount of neck motion due to the flexibility of the subaxial cervical spine. Distal

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Stephen M. Papadopoulos, Curtis A. Dickman and Volker K. H. Sonntag

without myelopathic deficits is still controversial. Patients with severe rheumatoid arthritis often have complex multisystem medical problems associated with the disease process, in addition to complicating side effects related to drug therapies. The operative mortality rate associated with cervical spine stabilization procedures ranges from approximately 5% to 15% 3, 4, 11, 24, 25, 31 The failure rate for atlantoaxial (C1–2) fusion may reach as high as 50%. 12 Nonetheless, many authors believe that “prophylactic” C1–2 fusion should be performed in select patients

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Hakan Bozkus and Curtis A. Dickman

our patient, we attempted to correct the deformity partially to reduce tension in the fusion area and to decrease stress on the instrumentation. The clinical outcome was excellent. This procedure may be useful for primary fixation and for revision of failed fusion involving high-grade lumbosacral spondylolisthesis. Conclusions Transsacral cage-augmented pedicle screw/rod fixation combined with posterolateral fusion provides immediate, circumferential rigid stabilization at the lumbosacral junction in the treatment of high-grade lumbosacral spondylolisthesis

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Robert F. Heary

The traditional treatment of neurosurgical spinal disorders involved decompression of the spinal cord and/or nerve roots. Fusion was utilized to stabilize segments that became unstable due to either progressive degenerative changes or iatrogenic changes resulting from a decompressive surgical procedure. An alternative, newer treatment has emerged in the form of dynamic stabilization, which provides more stability than is present following a decompression surgery and less rigidity than occurs following a fusion procedure. The value of dynamic stabilization is

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Atul Goel

when performing pediatric C1–2 and occipitocervical stabilizations. Use of these flow diagrams has led to successful fusion in 25 pediatric patients with difficult anatomy requiring less common constructs. T o T he E ditor : We have read 2 recent publications, 1 by Anderson et al. (Anderson RCE, Ragel BT, Mocco J, et al: Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg 107 (1 Suppl Pediatrics): 36–42, July, 2007) and the other by Jea et al. (Jea A, Taylor MD, Dirks PB, et al

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Li-Yu Fay, Peng-Yuan Chang, Jau-Ching Wu, Wen-Cheng Huang, Chun-Hao Wang, Tzu-Yun Tsai, Tsung-Hsi Tu, Hsuan-Kan Chang, Ching-Lan Wu and Henrich Cheng

, 17 , 18 , 30 , 31 Although there are still issues with this fusion surgery, spinal arthrodesis has been a popular choice of strategy of surgical management for lumbar spondylosis. 1 , 9 , 11 , 25 , 29 In recent decades, there has been an emerging option of dynamic stabilization for lumbar spondylosis with preservation of spinal segmental motion. The Dynesys dynamic stabilization (DDS) system (Zimmer Spine), a spinal motion preservation system, consists of a pedicle screw–based stabilization device for the lumbar spine. The DDS was designed to unload the

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Alberto Maleci, Rafael Donatus Sambale, Michele Schiavone, Franz Lamp, Fahir Özer and Archibald von Strempel

D egenerative disease of the lumbar spine affects adults in middle and advanced age. Pain is the leading symptom and occurs as low-back pain, unilateral or bilateral sciatica, and as combined lumbar and sciatic pain. In the vast majority of cases, conservative methods are appropriate to treat the symptoms successfully. If severe symptoms persist, and can no longer be tolerated by the patient, an operative procedure is indicated. There are no definite surgical modes of approach. A fundamental distinction can be made between decompression and stabilization

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Allan J. Belzberg and Bruce I. Tranmer

the case of an 18-year-old woman who survived an anterior atlanto-occipital dislocation. A review of the literature revealed that reported treatment of this injury is anecdotal and varied. Neither cervical traction nor halo fixation provided a satisfactory alignment in our patient. To achieve realignment and to provide both immediate and long-term stabilization of the atlanto-occipital joint, we used a modification of the contoured-steel loop posterior surgical fixation method, originally developed for postoperative atlantooccipital instability by Ransford, et al

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Christopher I. Shaffrey and Justin S. Smith

References 1 Ashman B , Norvell DC , Hermsmeyer JT : Chronic sacroiliac joint pain: fusion versus denervation as treatment options . Evid Based Spine Care J 1 : 35 – 44 , 2010 2 Geisler F : Stabilization of the Sacroiliac Joint (SIJ) with the SI-Bone Surgical Technique . Neurosurg Focus (Special Supplement) 33 : Video 8, 2013 3 Hancock MJ , Maher CG , Latimer J , Spindler MF , McAuley JH , Laslett M , Bogduk N : Systematic review of tests to identify the disc, SIJ or facet joint as the source of low back pain . Eur Spine J