Craniocervical abnormalities

A comprehensive surgical approach

Restricted access

✓ Guidelines are proposed for surgical management of symptomatic abnormalities of the craniocervical junction. Experience with 17 recent cases is described. Gas or metrizamide (Amipaque) myelograms with pluridirectional tomograms revealed the etiology and mechanisms of compression of the cervicomedullary junction, as well as its reducibility. Stabilization was the goal in treatment of reducible lesions. Decompression of the cervicomedullary junction was paramount in irreducible cases. Ventral compression was treated in nine patients by transoral transpalatine resection of the odontoid-clivus complex, and all nine improved. A posterior decompression was carried out when bone impingement was present from the dorsal aspect. Fusion was performed in cases in which stability was not achieved by either procedure.

Article Information

Address reprint requests to: Arnold H. Menezes, M.B., B.A., Division of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Approach to abnormalities of the cervicobasilar junction.

  • View in gallery

    Case 1. Upper: Gas myelogram showing the odontoid process indenting the cervicomedullary junction in flexion. Lower: The impingement was reduced in extension.

  • View in gallery

    Case 1. Preoperative (left) and postoperative (right) lateral roentgenograms. Atlantoaxial instability is corrected with wire and posterior fusion of C1–2 in extension.

  • View in gallery

    Case 2. Nonreducible ventral compression of the cervicomedullary junction by abnormal clivusodontoid articulation.

  • View in gallery

    Case 5. Left: Preoperative gas myelogram revealing ventral cervicomedullary compression by the invaginated odontoid. Right: Postoperative lateral tomogram reveals the extent of the clivus-C-1-odontoid resection to relieve ventral compression. No postoperative instability is present.

  • View in gallery

    Case 7. Gas myelogram illustrating the extent of odontoid compression of the medulla oblongata.

  • View in gallery

    Case 11. Upper: Metrizamide myelogram with cervicomedullary midline tomogram showing ventral and dorsal compression of the junction in flexion. Lower: In extension, the compression was mainly dorsal.

  • View in gallery

    Case 15. Metrizamide myelogram showing narrowing of the upper cervical spinal canal with dorsal indentation of the cervicomedullary junction at C-1. The posterior arch of C-1 is closely applied to the foramen magnum.

References

  • 1.

    Alexander E JrForsyth HFDavis CH Jret al: Dislocation of the atlas on the axis. J Neurosurg 15: 3533711958Alexander E Jr Forsyth HF Davis CH Jr et al: Dislocation of the atlas on the axis. J Neurosurg 15:353–371 1958

    • Search Google Scholar
    • Export Citation
  • 2.

    Apuzzo MLJWeiss MHHeiden J: Transoral exposure of the atlantoaxial region. Neurosurgery 3: 2012071978Apuzzo MLJ Weiss MH Heiden J: Transoral exposure of the atlantoaxial region. Neurosurgery 3:201–207 1978

    • Search Google Scholar
    • Export Citation
  • 3.

    Aring CE: Lesions about the junction of medulla and spinal cord. JAMA 229: 18791974(Editorial)Aring CE: Lesions about the junction of medulla and spinal cord. JAMA 229:1879 1974 (Editorial)

    • Search Google Scholar
    • Export Citation
  • 4.

    Bell C: The Nervous System of the Human Body. London: Longman, Rees, Orme, Brown and Green1830(Cited in Reference 28)Bell C: The Nervous System of the Human Body. London: Longman Rees Orme Brown and Green 1830 (Cited in Reference 28)

    • Search Google Scholar
    • Export Citation
  • 5.

    Belmusto LWoldring SOwens G: Localization and patterns of potentials of the respiratory pathway in the cervical spinal cord in the dog. J Neurosurg 22: 2772831965Belmusto L Woldring S Owens G: Localization and patterns of potentials of the respiratory pathway in the cervical spinal cord in the dog. J Neurosurg 22:277–283 1965

    • Search Google Scholar
    • Export Citation
  • 6.

    Bharucha EPDastur HM: Craniovertebral anomalies. (A report on 40 cases.)Brain 87: 4694801964Bharucha EP Dastur HM: Craniovertebral anomalies. (A report on 40 cases.) Brain 87:469–480 1964

    • Search Google Scholar
    • Export Citation
  • 7.

    Bonney G: Stabilization of the upper cervical spine by the transpharyngeal route. Proc R Soc Med 63: 8968971970Bonney G: Stabilization of the upper cervical spine by the transpharyngeal route. Proc R Soc Med 63:896–897 1970

    • Search Google Scholar
    • Export Citation
  • 8.

    Brill CBRose JSGodmilow Let al: Spastic quadriparesis due to C1–C2 subluxation in Hurler syndrome. J Pediatr 92: 4414431978Brill CB Rose JS Godmilow L et al: Spastic quadriparesis due to C1–C2 subluxation in Hurler syndrome. J Pediatr 92:441–443 1978

    • Search Google Scholar
    • Export Citation
  • 9.

    Bull JWDNixon WLBPratt RTCet al: Paget's disease of the skull and secondary basilar impression. Brain 82: 10221959Bull JWD Nixon WLB Pratt RTC et al: Paget's disease of the skull and secondary basilar impression. Brain 82:10–22 1959

    • Search Google Scholar
    • Export Citation
  • 10.

    Caetano de Barros MFarias WAtaíde Let al: Basilar impression and Arnold-Chiari malformation. J Neurol Neurosurg Psychiatry 31: 5966051968Caetano de Barros M Farias W Ataíde L et al: Basilar impression and Arnold-Chiari malformation. J Neurol Neurosurg Psychiatry 31:596–605 1968

    • Search Google Scholar
    • Export Citation
  • 11.

    Cannoni M: La voi trans-orale dans l'abord des lésions de la région du clivus. J Fr Otorhinolaryngol 27( 2): 81851978Cannoni M: La voi trans-orale dans l'abord des lésions de la région du clivus. J Fr Otorhinolaryngol 27(2):81–85 1978

    • Search Google Scholar
    • Export Citation
  • 12.

    Cogan DGBarrows LJ: Platybasia and Arnold-Chiari malformation. Arch Ophthalmol 52: 13291954Cogan DG Barrows LJ: Platybasia and Arnold-Chiari malformation. Arch Ophthalmol 52:13–29 1954

    • Search Google Scholar
    • Export Citation
  • 13.

    Dastur DKWadia NHDesai ADet al: Medullospinal compression due to atlanto-axial dislocation and sudden haematomyelia during decompression. Pathology, pathogenesis and clinical correlations. Brain 88: 8979241965Dastur DK Wadia NH Desai AD et al: Medullospinal compression due to atlanto-axial dislocation and sudden haematomyelia during decompression. Pathology pathogenesis and clinical correlations. Brain 88:897–924 1965

    • Search Google Scholar
    • Export Citation
  • 14.

    Davis DGutierrez FA: Congenital anomaly of the odontoid in children. Childs Brain 3: 2192291977Davis D Gutierrez FA: Congenital anomaly of the odontoid in children. Childs Brain 3:219–229 1977

    • Search Google Scholar
    • Export Citation
  • 15.

    De Andrade JRMacNab I: Anterior occipito-cervical fusion using an extra-pharyngeal exposure. J Bone Joint Surg (Am) 51: 162116261969De Andrade JR MacNab I: Anterior occipito-cervical fusion using an extra-pharyngeal exposure. J Bone Joint Surg (Am) 51:1621–1626 1969

    • Search Google Scholar
    • Export Citation
  • 16.

    Delandsheer JMCaron JPJomin M: [The transbuccopharyngeal approach and malformations of the cervico-occipital joint.] Neurochirurgie 23: 2762811977(Fr)Delandsheer JM Caron JP Jomin M: [The transbuccopharyngeal approach and malformations of the cervico-occipital joint.] Neurochirurgie 23:276–281 1977 (Fr)

    • Search Google Scholar
    • Export Citation
  • 17.

    Dolan KD: Cervicobasilar relationships. Radiol Clin North Am 15( 2): 1551661977Dolan KD: Cervicobasilar relationships. Radiol Clin North Am 15(2):155–166 1977

    • Search Google Scholar
    • Export Citation
  • 18.

    Estridge MNSmith RA: Transoral fusion of odontoid fracture. Case report. J Neurosurg 27: 4624651967Estridge MN Smith RA: Transoral fusion of odontoid fracture. Case report. J Neurosurg 27:462–465 1967

    • Search Google Scholar
    • Export Citation
  • 19.

    Evarts CMLonsdale D: Ossiculum terminale — an anomaly of the odontoid process. Report of a case of atlantoaxial dislocation with cord compression. Cleveland Clin Q 37: 73761970Evarts CM Lonsdale D: Ossiculum terminale — an anomaly of the odontoid process. Report of a case of atlantoaxial dislocation with cord compression. Cleveland Clin Q 37:73–76 1970

    • Search Google Scholar
    • Export Citation
  • 20.

    Fang HSYOng GB: Direct anterior approach to the upper cervical spine. J Bone Joint Surg (Am) 44: 158816041962Fang HSY Ong GB: Direct anterior approach to the upper cervical spine. J Bone Joint Surg (Am) 44:1588–1604 1962

    • Search Google Scholar
    • Export Citation
  • 21.

    Ferlic DCClayton MLLeidholt JDet al: Surgical treatment of the symptomatic unstable cervical spine in rheumatoid arthritis. J Bone Joint Surg (Am) 57: 3493541975Ferlic DC Clayton ML Leidholt JD et al: Surgical treatment of the symptomatic unstable cervical spine in rheumatoid arthritis. J Bone Joint Surg (Am) 57:349–354 1975

    • Search Google Scholar
    • Export Citation
  • 22.

    Fielding JWGriffin PP: Os odontoideum: an acquired lesion. J Bone Joint Surg (Am) 56: 1871901974Fielding JW Griffin PP: Os odontoideum: an acquired lesion. J Bone Joint Surg (Am) 56:187–190 1974

    • Search Google Scholar
    • Export Citation
  • 23.

    Fromm GHPitner SE: Late progressive quadriparesis due to odontoid agenesis. Arch Neurol 9: 2912961963Fromm GH Pitner SE: Late progressive quadriparesis due to odontoid agenesis. Arch Neurol 9:291–296 1963

    • Search Google Scholar
    • Export Citation
  • 24.

    Ganguly DNRoy KK: A study on the cranio-vertebral joint in the man. Anat Anz 114: 4334521964Ganguly DN Roy KK: A study on the cranio-vertebral joint in the man. Anat Anz 114:433–452 1964

    • Search Google Scholar
    • Export Citation
  • 25.

    Gaufin LMGoodman SJ: Cervical spine injuries in infants. Problems in management. J Neurosurg 42: 1791841975Gaufin LM Goodman SJ: Cervical spine injuries in infants. Problems in management. J Neurosurg 42:179–184 1975

    • Search Google Scholar
    • Export Citation
  • 26.

    Gilles RHBina MSotrel A: Infantile atlantoccipital instability. The potential danger of extreme extension. Am J Dis Child 133: 30371979Gilles RH Bina M Sotrel A: Infantile atlantoccipital instability. The potential danger of extreme extension. Am J Dis Child 133:30–37 1979

    • Search Google Scholar
    • Export Citation
  • 27.

    Gillman EL: Congenital absence of the odontoid process of the axis. Report of a case. J Bone Joint Surg (Am) 41: 3453481959Gillman EL: Congenital absence of the odontoid process of the axis. Report of a case. J Bone Joint Surg (Am) 41:345–348 1959

    • Search Google Scholar
    • Export Citation
  • 28.

    Greenberg AD: Atlanto-axial dislocations. Brain 91: 6556841968Greenberg AD: Atlanto-axial dislocations. Brain 91:655–684 1968

  • 29.

    Greenberg ADScoville WBDavey LM: Transoral decompression of the atlantoaxial dislocation due to odontoid hypoplasia. Report of two cases. J Neurosurg 28: 2662691968Greenberg AD Scoville WB Davey LM: Transoral decompression of the atlantoaxial dislocation due to odontoid hypoplasia. Report of two cases. J Neurosurg 28:266–269 1968

    • Search Google Scholar
    • Export Citation
  • 30.

    Grote WRömer FBettag W: Der ventrale Zugang zum Dens epitropheus. Langenbecks Arch Chir 331: 15221972Grote W Römer F Bettag W: Der ventrale Zugang zum Dens epitropheus. Langenbecks Arch Chir 331:15–22 1972

    • Search Google Scholar
    • Export Citation
  • 31.

    Gulati DRRout D: Atlantoaxial dislocation with quadriparesis in achondroplasia. Case report. J Neurosurg 40: 3943961974Gulati DR Rout D: Atlantoaxial dislocation with quadriparesis in achondroplasia. Case report. J Neurosurg 40:394–396 1974

    • Search Google Scholar
    • Export Citation
  • 32.

    Hall CWDanoff D: Sleep attacks — apparent relationship to atlantoaxial dislocation. Arch Neurol 32: 57581975Hall CW Danoff D: Sleep attacks — apparent relationship to atlantoaxial dislocation. Arch Neurol 32:57–58 1975

    • Search Google Scholar
    • Export Citation
  • 33.

    Hess JHBronstein IPAbelson SM: Atlanto-axial dislocations. Unassociated with trauma and secondary to inflammatory foci in the neck. Am J Dis Child 49: 113711471935Hess JH Bronstein IP Abelson SM: Atlanto-axial dislocations. Unassociated with trauma and secondary to inflammatory foci in the neck. Am J Dis Child 49:1137–1147 1935

    • Search Google Scholar
    • Export Citation
  • 34.

    Holmes JCHall JE: Fusion for instability and potential instability of the cervical spine in children and adolescents. Orthop Clin North Am 9: 9239431978Holmes JC Hall JE: Fusion for instability and potential instability of the cervical spine in children and adolescents. Orthop Clin North Am 9:923–943 1978

    • Search Google Scholar
    • Export Citation
  • 35.

    Hurwitz LJShepherd WHT: Basilar impression and disordered metabolism of bone. Brain 89: 2232341966Hurwitz LJ Shepherd WHT: Basilar impression and disordered metabolism of bone. Brain 89:223–234 1966

    • Search Google Scholar
    • Export Citation
  • 36.

    Kopits SEPerovic MNMcKusick Vet al: Congenital atlantoaxial dislocations in various forms of dwarfism. J Bone Joint Surg (Am) 54: 134913501972(Abstract)Kopits SE Perovic MN McKusick V et al: Congenital atlantoaxial dislocations in various forms of dwarfism. J Bone Joint Surg (Am) 54:1349–1350 1972 (Abstract)

    • Search Google Scholar
    • Export Citation
  • 37.

    Krieger AJRosomoff HL: Sleep-induced apnea. Part 1: A respiratory and autonomic dysfunction syndrome following bilateral percutaneous cervical cordotomy. J Neurosurg 40: 1681801974Krieger AJ Rosomoff HL: Sleep-induced apnea. Part 1: A respiratory and autonomic dysfunction syndrome following bilateral percutaneous cervical cordotomy. J Neurosurg 40:168–180 1974

    • Search Google Scholar
    • Export Citation
  • 38.

    Krieger AJRosomoff HL: Sleep-induced apnea. Part 2: Respiratory failure after anterior spinal surgery. J Neurosurg 40: 1811851974Krieger AJ Rosomoff HL: Sleep-induced apnea. Part 2: Respiratory failure after anterior spinal surgery. J Neurosurg 40:181–185 1974

    • Search Google Scholar
    • Export Citation
  • 39.

    Lippmann RK: Arthropathy due to adjacent inflammation. J Bone Joint Surg (Am) 35: 9679791953Lippmann RK: Arthropathy due to adjacent inflammation. J Bone Joint Surg (Am) 35:967–979 1953

    • Search Google Scholar
    • Export Citation
  • 40.

    List CF: Neurologic syndromes accompanying developmental anomalies of occipital bone, atlas and axis. Arch Neurol Psychiatry 45: 5776161941List CF: Neurologic syndromes accompanying developmental anomalies of occipital bone atlas and axis. Arch Neurol Psychiatry 45:577–616 1941

    • Search Google Scholar
    • Export Citation
  • 41.

    Lourie HStewart WA: Spontaneous atlantoaxial dislocation. A complication of rheumatoid disease. N Engl J Med 265: 6776811961Lourie H Stewart WA: Spontaneous atlantoaxial dislocation. A complication of rheumatoid disease. N Engl J Med 265:677–681 1961

    • Search Google Scholar
    • Export Citation
  • 42.

    McRae DL: The significance of abnormalities of the cervical spine. Am J Roentgenol Radium Ther 84: 3251960McRae DL: The significance of abnormalities of the cervical spine. Am J Roentgenol Radium Ther 84:3–25 1960

    • Search Google Scholar
    • Export Citation
  • 43.

    Michie IClark M: Neurological syndromes associated with cervical and craniocervical anomalies. Arch Neurol 18: 2412471968Michie I Clark M: Neurological syndromes associated with cervical and craniocervical anomalies. Arch Neurol 18:241–247 1968

    • Search Google Scholar
    • Export Citation
  • 44.

    Mikulowski PWollheim FARotmil Pet al: Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand 198: 4454511975Mikulowski P Wollheim FA Rotmil P et al: Sudden death in rheumatoid arthritis with atlanto-axial dislocation. Acta Med Scand 198:445–451 1975

    • Search Google Scholar
    • Export Citation
  • 45.

    Mullan SNaunton RHekmatpanah Jet al: The use of an anterior approach to ventrally placed tumors in the foramen magnum and vertebral column. J Neurosurg 24: 5365431966Mullan S Naunton R Hekmatpanah J et al: The use of an anterior approach to ventrally placed tumors in the foramen magnum and vertebral column. J Neurosurg 24:536–543 1966

    • Search Google Scholar
    • Export Citation
  • 46.

    Nagashima C: Atlanto-axial dislocation due to agenesis of the os odontoideum or odontoid. J Neurosurg 33: 2702801970Nagashima C: Atlanto-axial dislocation due to agenesis of the os odontoideum or odontoid. J Neurosurg 33:270–280 1970

    • Search Google Scholar
    • Export Citation
  • 47.

    Nagashima C: Surgical treatment of irreducible atlanto-axial dislocation with spinal cord compression. Case report. J Neurosurg 38: 3743781973Nagashima C: Surgical treatment of irreducible atlanto-axial dislocation with spinal cord compression. Case report. J Neurosurg 38:374–378 1973

    • Search Google Scholar
    • Export Citation
  • 48.

    Nathan PW: The descending respiratory pathway in man. J Neurol Neurosurg Psychiatry 26: 4874991963Nathan PW: The descending respiratory pathway in man. J Neurol Neurosurg Psychiatry 26:487–499 1963

    • Search Google Scholar
    • Export Citation
  • 49.

    Ochiai YYamamoto MTakeshita Ket al: Myelopathy in infancy complicating congenital atlantoaxial dislocation. Am J Dis Child 130: 127012711976Ochiai Y Yamamoto M Takeshita K et al: Myelopathy in infancy complicating congenital atlantoaxial dislocation. Am J Dis Child 130:1270–1271 1976

    • Search Google Scholar
    • Export Citation
  • 50.

    O'Leary PRanawat CSPellicci PM: The cervical spine in rheumatoid arthritis. Contemp Surg 7: 13171975O'Leary P Ranawat CS Pellicci PM: The cervical spine in rheumatoid arthritis. Contemp Surg 7:13–17 1975

    • Search Google Scholar
    • Export Citation
  • 51.

    Paradis RWSax DS: Familial basilar impression. Neurology 22: 5545601972Paradis RW Sax DS: Familial basilar impression. Neurology 22:554–560 1972

    • Search Google Scholar
    • Export Citation
  • 52.

    Paramonov LV: [Surgical treatment of craniovertebral anomalies.] Vopr Neirokhir 35: 9151971(Rus)Paramonov LV: [Surgical treatment of craniovertebral anomalies.] Vopr Neirokhir 35:9–15 1971 (Rus)

    • Search Google Scholar
    • Export Citation
  • 53.

    Parke WW: The vascular relations of the upper cervical vertebrae. Orthop Clin North Am 9: 8798891978Parke WW: The vascular relations of the upper cervical vertebrae. Orthop Clin North Am 9:879–889 1978

    • Search Google Scholar
    • Export Citation
  • 54.

    Pech ACannoni MMagnan Jet al: [The trans-oral approach in oto-neurosurgery.] Ann Otolaryngol Chir Cervicofac 91: 2812921974(Fr)Pech A Cannoni M Magnan J et al: [The trans-oral approach in oto-neurosurgery.] Ann Otolaryngol Chir Cervicofac 91:281–292 1974 (Fr)

    • Search Google Scholar
    • Export Citation
  • 55.

    Roy LGibson DA: Cervical spine fusions in children. Clin Orthop 73: 1461511970Roy L Gibson DA: Cervical spine fusions in children. Clin Orthop 73:146–151 1970

    • Search Google Scholar
    • Export Citation
  • 56.

    Saez RJOnofrio BMYanaghihara T: Experience with Arnold-Chiari malformation, 1960 to 1970. J Neurosurg 45: 4164221976Saez RJ Onofrio BM Yanaghihara T: Experience with Arnold-Chiari malformation 1960 to 1970. J Neurosurg 45:416–422 1976

    • Search Google Scholar
    • Export Citation
  • 57.

    Schneider RCSchemm GW: Vertebral artery insufficiency in acute and chronic spinal trauma. J Neurosurg 18: 3483601961Schneider RC Schemm GW: Vertebral artery insufficiency in acute and chronic spinal trauma. J Neurosurg 18:348–360 1961

    • Search Google Scholar
    • Export Citation
  • 58.

    Shapiro RYoungberg ASRothman SLG: The differential diagnosis of traumatic lesions of the occipito-atlanto-axial segment. Radiol Clin North Am 11( 3): 5055261973Shapiro R Youngberg AS Rothman SLG: The differential diagnosis of traumatic lesions of the occipito-atlanto-axial segment. Radiol Clin North Am 11(3):505–526 1973

    • Search Google Scholar
    • Export Citation
  • 59.

    Sharp JPurser DW: Spontaneous atlanto-axial dislocation in ankylosing spondylitis and rheumatoid arthritis. Ann Rheum Dis 20: 47771961Sharp J Purser DW: Spontaneous atlanto-axial dislocation in ankylosing spondylitis and rheumatoid arthritis. Ann Rheum Dis 20:47–77 1961

    • Search Google Scholar
    • Export Citation
  • 60.

    Silvernail WLBrown RBPool CC: Medullo-spinal decompression and fusion for atlanto-axial dislocation due to hydroplastic separate odontoid. Pa Med 75: 58601972Silvernail WL Brown RB Pool CC: Medullo-spinal decompression and fusion for atlanto-axial dislocation due to hydroplastic separate odontoid. Pa Med 75:58–60 1972

    • Search Google Scholar
    • Export Citation
  • 61.

    Singer WDHaller JSWolpert SM: Occlusive vertebrovascular artery disease associated with cervical spine anomaly. Am J Dis Child 129: 4924951975Singer WD Haller JS Wolpert SM: Occlusive vertebrovascular artery disease associated with cervical spine anomaly. Am J Dis Child 129:492–495 1975

    • Search Google Scholar
    • Export Citation
  • 62.

    Skok PKapp JTroland CE: Spontaneous dislocation of the atlas. J Neurosurg 21: 2192221964Skok P Kapp J Troland CE: Spontaneous dislocation of the atlas. J Neurosurg 21:219–222 1964

    • Search Google Scholar
    • Export Citation
  • 63.

    Smith GWRobinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 40: 6076241958Smith GW Robinson RA: The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 40:607–624 1958

    • Search Google Scholar
    • Export Citation
  • 64.

    Spillane JDPallis CJones AM: Developmental abnormalities in the region of the foramen magnum. Brain 80: 11481957Spillane JD Pallis C Jones AM: Developmental abnormalities in the region of the foramen magnum. Brain 80:11–48 1957

    • Search Google Scholar
    • Export Citation
  • 65.

    Stevenson GCStoney RJPerkins RKet al: A transcervical transclival approach to the ventral surface of the brain stem for removal of a clivus chordoma. J Neurosurg 24: 5445511966Stevenson GC Stoney RJ Perkins RK et al: A transcervical transclival approach to the ventral surface of the brain stem for removal of a clivus chordoma. J Neurosurg 24:544–551 1966

    • Search Google Scholar
    • Export Citation
  • 66.

    Stratford J: Myelopathy caused by atlanto-axial dislocation. J Neurosurg 14: 971041957Stratford J: Myelopathy caused by atlanto-axial dislocation. J Neurosurg 14:97–104 1957

    • Search Google Scholar
    • Export Citation
  • 67.

    Sukoff MHKadin MMMoran T: Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine. Case report. J Neurosurg 37: 4934971972Sukoff MH Kadin MM Moran T: Transoral decompression for myelopathy caused by rheumatoid arthritis of the cervical spine. Case report. J Neurosurg 37:493–497 1972

    • Search Google Scholar
    • Export Citation
  • 68.

    Sullivan AW: Subluxation of the atlanto-axial joint: sequel to inflammatory processes of the neck. J Pediatr 35: 4514641949Sullivan AW: Subluxation of the atlanto-axial joint: sequel to inflammatory processes of the neck. J Pediatr 35:451–464 1949

    • Search Google Scholar
    • Export Citation
  • 69.

    Symonds CPMeadows SP: Compression of the spinal cord in the neighbourhood of the foramen magnum. With a note on the surgical approach, by Julian Taylor. Brain 60: 52841937Symonds CP Meadows SP: Compression of the spinal cord in the neighbourhood of the foramen magnum. With a note on the surgical approach by Julian Taylor. Brain 60:52–84 1937

    • Search Google Scholar
    • Export Citation
  • 70.

    Taylor ARByrnes DP: Foramen magnum and high cervical cord compression. Brain 97: 4734801974Taylor AR Byrnes DP: Foramen magnum and high cervical cord compression. Brain 97:473–480 1974

    • Search Google Scholar
    • Export Citation
  • 71.

    Taylor ARChakravorty BC: Clinical syndromes associated with basilar impression. Arch Neurol 10: 4754841964Taylor AR Chakravorty BC: Clinical syndromes associated with basilar impression. Arch Neurol 10:475–484 1964

    • Search Google Scholar
    • Export Citation
  • 72.

    Wadia NH: Myelopathy complicating congenital atlanto-axial dislocation. (A study of 28 cases.) Brain 90: 4494721967Wadia NH: Myelopathy complicating congenital atlanto-axial dislocation. (A study of 28 cases.) Brain 90:449–472 1967

    • Search Google Scholar
    • Export Citation
  • 73.

    White AA IIIPanjabi MM: The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 9: 8678781978White AA III Panjabi MM: The clinical biomechanics of the occipitoatlantoaxial complex. Orthop Clin North Am 9:867–878 1978

    • Search Google Scholar
    • Export Citation
  • 74.

    Wollin DG: The os odontoideum. Separate odontoid process. J Bone Joint Surg (Am) 45: 145914711963Wollin DG: The os odontoideum. Separate odontoid process. J Bone Joint Surg (Am) 45:1459–1471 1963

    • Search Google Scholar
    • Export Citation
  • 75.

    Zingesser LH: Radiological aspects of anomalies of the upper cervical spine and craniocervical junction. Clin Neurosurg 20: 2202311973Zingesser LH: Radiological aspects of anomalies of the upper cervical spine and craniocervical junction. Clin Neurosurg 20:220–231 1973

    • Search Google Scholar
    • Export Citation

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 210 210 30
Full Text Views 293 293 4
PDF Downloads 101 101 0
EPUB Downloads 0 0 0

PubMed

Google Scholar