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Biomed Res Int 2020 15;2020:5395071. Epub 2020 Dec 15.

The Department of Spine Surgery, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an 710054, China.

Background: Many doctors ignored the possibility that there is still a spinal cord compression (SCC) need for decompression after atlantoaxial reduction. Reduction can be achieved on kinematic magnetic resonance imaging (MRI); thus, we want to analyze the role of kinematic MRI in reducible atlantoaxial dislocation and make a preoperative decision whether to perform decompression.

Methods: 36 patients with atlantoaxial reduction on preoperative kinematic MRI in extension postures were enrolled retrospectively. Read More

J Manipulative Physiol Ther 2020 Jul - Aug;43(6):579-587. Epub 2020 Aug 26.

School of Health Sciences, The University of Newcastle, Newcastle, Australia.

Objective: The composition of cervical-spine meniscoids may have clinical significance in neck-pain conditions, but the accuracy of assessment of meniscoid composition in vivo using magnetic resonance imaging has not been established. The aim of this study was to compare cervical-spine meniscoid composition by magnetic resonance imaging with histologic composition.

Methods: Four embalmed cadaveric cervical spines (mean [standard deviation] age, 79. Read More

World Neurosurg 2020 08;140:556-563

Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Mumbai, India.

Background: Ossification of the posterior longitudinal ligament (OPLL) is a hyperostotic condition resulting in a progressive narrowing of the spinal canal and subsequent neurologic deficits. Although systemic and local factors in combination with genetic abnormality have been considered in its etiopathogenesis, OPLL remains a poorly understood pathology. Surgical management of OPLL and the choice of the most appropriate treatment are still controversial issues. Read More

Zhongguo Gu Shang 2019 Sep;32(9):819-823

Department of Orthopaedics, Changzheng Hospital Affiliated to Naval Military Medical University, Shanghai 200003, China;

Objective: To evaluate the effect of bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft on atlantoaxial dislocation caused by acute type I transverse ligament injury in school-age children.

Methods: From February 2006 to February 2019, 8 school-age children with atlantoaxial dislocation caused by acute type I transverse ligament injury were systematically reviewed, including 6 males and 2 females; aged 9 to 12 years old; 8 acute injuries included 4 high-level falls, 2 car accidents and 2 sports injuries; the atlantoaxial interval(ADI) was 5 to 8 mm. Eight cases presented with pain, stiffness, numbness and cervical spine dysfunction in different degrees. Read More

Biomed Res Int 2019 18;2019:5297950. Epub 2019 Mar 18.

Department of Orthopaedics, Spine and Trauma Surgery, Helios Klinikum Siegburg, Siegburg, Germany.

Traumatic atlantoaxial dislocation due to ligamentous and combined osseous injuries rarely occurs in adults. There are only few cases published in the literature. In this level 4 study, a cohort of nine consecutive patients suffering from traumatic atlantoaxial dislocation has been analyzed regarding morphology of injury, trauma mechanism, and outcome since 2007. Read More

PM R 2019 04 19;11(4):440-445. Epub 2019 Feb 19.

Division of Neurosurgery, University of Missouri School Medicine, Columbia, MO 65212.

Individuals with spinal cord injury (SCI) have altered neurophysiology and present with symptoms that must be interpreted in the context of their specific neurologic injury. This is a case of a 16-year-old female adolescent with C5 American Spinal Injury Association Impairment Scale A SCI who presented with intractable nausea. Multiple etiologies for her nausea, including medication effect, metabolic and gastrointestinal disorders, autonomic dysreflexia, and mood disorder, were systematically ruled out. Read More

Br J Neurosurg 2020 Oct 19;34(5):508-511. Epub 2018 Nov 19.

Department of Neurosurgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan.

Although dysphagia is known potential complication of cervical spine surgery, it rarely occurs after a posterior approach. We describe an unusual case of a retro-odontoid pseudotumor that suffered dysphagia following a C1 laminectomy and posterior atlantoaxial fixation. A 79-year-old man presented with progressive tetraparesis and bladder and bowel dysfunction due to severe compression to cervical cord at C1 from a retro-odontoid pseudotumor. Read More

J Am Acad Orthop Surg 2019 Mar;27(5):e242-e248

From the Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China.

Background: In theory, temporary posterior atlantoaxial screw-rod fixation for type II odontoid fractures is a way to preserve rotatory motion. However, the healing rate of type II odontoid fractures treated in this way is unknown; that is, the risk associated with conducting a temporary screw-rod fixation for type II odontoid fractures is unknown. This study investigates the healing rate of type II odontoid fractures treated with posterior atlantoaxial screw-rod fixation by CT imaging and evaluates the feasibility of conducting a temporary screw-rod fixation for type II odontoid fractures. Read More

Joint Bone Spine 2019 07 4;86(4):519-521. Epub 2018 Oct 4.

Rheumatology, Xarxa Universitària Fundació Althaia, Manresa, Joan Soler, 1-3, Manresa 08243, Barcelona, Spain.

Spine (Phila Pa 1976) 2019 03;44(5):E306-E314

Department of Spine Surgery, Center for Orthopedics, Daping Hospital, Army Medical University.

Detailed clinical information of 13 adult patients with acute atlantal fractures underwent nonoperative treatment was retrospectively studied. "Rule of Spence" was found inaccurate in predicting either integrity of transverse atlantal ligament (TAL) or atlantoaxial stability, whereas Dickman's classification of TAL injury was more superior to "rule of Spence" on both prediction.

Study Design: A retrospective study. Read More

World Neurosurg 2018 Oct 19;118:e925-e932. Epub 2018 Jul 19.

Department of Neurosurgery, Sahaydri Superspeciality Hospital, Nashik, Maharashtra, India.

Objective: Deliberate C2 nerve root sectioning and its preservation have been described during posterior fusion for atlantoaxial dislocation (AAD). However, the associated outcomes have been less studied, especially in congenital AAD. Our objective was to study the clinical outcomes after C2 nerve root sectioning and the feasibility of C2 preservation in these patients. Read More

Eur Spine J 2019 06 2;28(Suppl 2):9-12. Epub 2018 Jul 2.

Department of Neurosurgery, Southmead Hospital, Bristol, UK.

Purpose: Traumatic atlantoaxial dislocation (AAD) is usually associated with fatal high-velocity road traffic accidents (Xu et al. in Medicine (Baltimore) 94:e1768, 2015). There are few reports of survival following posterior AAD without odontoid fracture (Xu et al. Read More

Clin Neurol Neurosurg 2018 02 21;165:15-20. Epub 2017 Dec 21.

Neurosurgery, PGIMER, Chandigarh, India. Electronic address:

Objectives: Manifestation of congenital anomalies of cranio-vertebral junction (CVJ) in the later half of life is unusual and intriguing. Coexisting cervical spondylotic changes with multilevel compression, poorer bone quality as well as less smooth post-surgical recuperation make management of elderly Congenital Atlantoaxial Dislocation/ Basilar Invagination (CAAD/BI) challenging. The clinico-radiological presentation, pathogenesis and outcome are analysed here. Read More

Acta Orthop Traumatol Turc 2018 May 23;52(3):240-243. Epub 2017 Nov 23.

Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea. Electronic address:

Brown-Sequard syndrome is an uncommon complication of atlantoaxial arthrodesis. A 50-year-old female visited our emergency department after falling from a ladder. Radiologic evaluations revealed chronic C1-2 instability with acute spinal cord injury. Read More

Musculoskelet Sci Pract 2018 02 10;33:46-52. Epub 2017 Nov 10.

Discipline of Physiotherapy, The University of Newcastle, University Drive, Callaghan, 2308, NSW, Australia.

Background: Lateral atlantoaxial (LAA) joints are established sources of nociceptive input in chronic whiplash associated disorder (WAD). These joints contain intra-articular meniscoids that may be damaged in whiplash trauma. LAA joint meniscoid morphology has not been investigated comprehensively in a chronic WAD population, and it is unclear whether morphological differences exist compared to a pain-free population. Read More

Arch Orthop Trauma Surg 2017 Oct 29;137(10):1349-1355. Epub 2017 Aug 29.

Department of Orthopedics, The Second Affiliated Hospital, Chongqing Medical University, No. 76 Linjiang Road, Yuzhong District, Chongqing, 400010, People's Republic of China.

Introduction: Current surgical methods to treat atlantoaxial instability pose potential risks to the surrounding blood vessels and nerves of operative approach. Therefore, more secure and highly effective methods are expected. This study sought to assess the biomechanical efficacy of a novel unilateral double screw-rod fixation system by comparing with traditional and emerging fixation methods in cadaveric models. Read More

J Spine Surg 2017 Jun;3(2):267-271

1Division of Neurosurgery, Department of Surgery, 2Division of Neuroradiology, Department of Radiology, McMaster University, Hamilton, Ontario, Canada.

Atlantoaxial procedures have been developed in an effort to ensure solid C1-C2 fusion. However, techniques that involve sublaminar wiring have the potential for neural structure injury. We present the management of a patient who previously underwent Gallie fusion 10 years ago and is presenting with a dislodged titanium wire that has migrated into the medulla oblongata. Read More

Childs Nerv Syst 2017 Aug 6;33(8):1253-1260. Epub 2017 Jul 6.

Division of Pediatric Neurosurgery, Dell Children's Hospital, Austin, TX, USA.

Background: The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy.

Discussion: We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses. Read More

Z Orthop Unfall 2017 Jun 6;155(3):318-323. Epub 2017 Jul 6.

Klinik und Poliklinik für Orthopädie und Unfallchirurgie, Uniklinik Köln.

The odontoid process and the transverse ligament are the most important structures stabilising the atlantoaxial complex. It has not been fully elucidated how injuries of these structures contribute towards instability and a potential narrowing of the spinal canal. Therefore, our investigation aimed to perform a biomechanical analysis of spinal width and dislocation of the odontoid process depending on injuries of the aforementioned structures. Read More

Osteoporos Int 2017 06 2;28(6):1931-1938. Epub 2017 Mar 2.

Department of Neurosurgery, Hanyang University Medical Center, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 133-792, South Korea.

Osteopenia and osteoporosis were independent predictive factors for higher atlantoaxial subluxation occurrence in patients with lower body mass index. Our findings suggest that patients with rheumatoid arthritis with osteopenia or osteoporosis, particularly those with lower body mass index (BMI), should be screened regularly to determine the status of their cervical spines.

Introduction: Cervical spine involvement in rheumatoid arthritis (RA) patients may cause serious adverse effects on quality of life and overall health. Read More

Biomed Eng Online 2016 Dec 28;15(Suppl 2):168. Epub 2016 Dec 28.

School of Biomedical Engineering, Capital Medical University, Beijing, 100069, China.

Background: Basilar invagination (BI) combined with atlantoaxial dislocation (AAD) leads to foramen magnum stenosis and medullary spinal cord compression, causing nerve dysfunction. The purpose of the surgery is to remove the bony compression at brainstem ventral side and fix the unstable spinal segment and make it fused stably. Occipital cervical internal fixation system that simultaneously reduces atlantoaxial horizontal and vertical dislocation are established. Read More

J Orthop Sci 2017 Mar 12;22(2):213-217. Epub 2016 Nov 12.

Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Background: C1 lateral mass screw was widely used for fixation of the upper cervical spine. However, massive bleeding from the C1-2 venous plexus is sometimes encountered. In this study, we proposed an alternate method for C1 lateral mass screw insertion, which involves insertion of the screws caudally from the C2 nerve root to reduce bleeding from C1-2 venous plexus. Read More

World Neurosurg 2016 Sep 23;93:293-8. Epub 2016 Jun 23.

Department of Orthopedics, The Second Affiliated Hospital, The Second Military Medical University, Shanghai, China. Electronic address:

Objective: To evaluate the biomechanical stability of 3 atlantoaxial proactive vertebral artery injury prevention fixation combinations.

Methods: We used 6 fresh human cadaveric C0-C4 specimens for the biomechanical test with moment control in 6 loading directions. First, range of motion (ROM) was measured in the intact specimens before they were destabilized; next, ROM of the 4 conditions fixed with 4 different fixation combinations were tested in alternating sequence: bilateral transarticular screw (TAS) and 3 test combinations: C1 laminar hook (C1LH) and C2 intralaminar screw (C2ILS) on 1 side combined with TAS (C1LH-C2ILS/TAS) or C1LH and TAS (C1LH-C2ILS/C1LH-TAS) or C1LH and C2ILS on the other side (C1LH-C2ILS/C1LH-C2ILS). Read More

Zhonghua Yi Xue Za Zhi 2015 Sep;95(35):2829-33

Department of Spinal Surgery, the First Affiliated Hospital of Xinjiang Medical University, Xinjiang Urmuqi 830054, China; Email:

Objective: To evaluate the indications and effect of surgical treatment of basilar invagination (BI) with atlantoaxial dislocation (AAD) on the basis of retrospective analysis of the clinical and imaging data of patients.

Methods: Consecutive 21 patients with BI and AAD were surgically treated in Department of Spinal Surgery, The First Affiliated Hospital of Xinjiang Medical University from July 2000 to December 2013. There were 10 males and 11 females, aged from 7 to 59 years, with a mean of 36. Read More

Spine (Phila Pa 1976) 2016 Jun;41(12):E725-E732

Orthopaedic Department, Peking University Third Hospital, Beijing, China.

Study Design: Retrospective case series of atlantoaxial rotatory fixed dislocation (AARFD).

Objective: To describe clinical features and the surgical treatment of AARFD.

Summary Of Background Data: The classification and treatment strategy for atlantoaxial rotatory fixation (AARF) were previously described and remained controversial. Read More

Semin Arthritis Rheum 2015 Aug 5;45(1):9-17. Epub 2015 Mar 5.

Department of Rheumatology (Planta 10-2), Hospital Universitario de Bellvitge-IDIBELL, Feixa Llarga s/n, Hospitalet de Llobregat, Barcelona 08907, Spain.

Objective: To investigate the frequency, location, characteristics, and clinical significance of subaxial involvement (below C1-C2) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine.

Methods: A total of 41 patients with RA were examined via cervical spine magnetic resonance imaging (MRI). A comparative analysis of the incidence of the different types of subaxial lesions was performed between these patients and 41 age- and sex-matched patients with symptomatic cervical spondylosis. Read More

Mod Rheumatol 2017 Sep 29;27(5):901-904. Epub 2015 Jun 29.

a Department of Orthopedic Surgery , Hokkaido University Graduate School of Medicine , Sapporo , Japan.

To highlight the risk of cervical myelopathy due to occult, atraumatic odontoid fracture in patients with rheumatoid arthritis, we retrospectively reviewed radiographic findings and clinical observations for 7 patients with this disorder. This fracture tends to occur in patients with long-lasting rheumatoid arthritis and to be misdiagnosed as simple atlantoaxial dislocation. Since this fracture causes multidirectional instability between C1 and C2 and is expected to have poor healing potential due to bone erosion and inadequate blood supply, posterior spinal arthrodesis surgery is indicated upon identification of the fracture to prevent myelopathy. Read More

Spine J 2015 Jul 7;15(7):1618-28. Epub 2015 Feb 7.

MERC (Musculoskeletal Education and Research Center), Globus Medical, Inc., 2560 General Armistead Ave., Audubon, PA 19403, USA.

Background Context: Occipitocervical dislocations involve translations of the craniocervical joints. The relative contributions of each ligament to overall stability and the effects of the occipitoatlantal joint capsules on the pathologic translation are unknown. Although incidences of occipitocervical dislocations are rare after blunt trauma, they are usually fatal. Read More

Eur Spine J 2015 Apr 28;24(4):686-93. Epub 2014 Dec 28.

Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie Fang Road, Hangzhou, 310009, Zhejiang, People's Republic of China.

Purpose: To assess the feasibility of temporary pedicle screw fixation for motion preservation of type II odontoid fractures unsuitable for anterior screw.

Methods: Between 2012 and 2013, temporary pedicle screw fixation was performed in 13 patients with type II odontoid fractures unsuitable for anterior screw. The patients were 10 men and 3 women with an average age of 40. Read More