• Peng Zhang, Genyang Jin, Zijie Sun, Jiayao Jiang, and Qi Liu.
• Department of Orthopedics, The 904th Hospital of Joint Logistic Support Force of PLA, Shanghai, China.
• World Neurosurg. 2023 Apr 1; 172: e220e224e220-e224.

ObjectiveTo evaluate the stability and function of the C1-C2 joint after ectopic functional reconstruction (EFR) of the C1 transverse ligament.MethodsEight human cadaveric cervical spines (C0-C4) were subjected to in vitro biomechanical test with moment control. Spine specimens were tested under the following conditions: 1) left intact; 2) destabilized by severing the transverse ligament of atlas; 3) after EFR of the transverse ligament. Range of motion was measured in flexion, extension, lateral bending, and axial rotation.ResultsDestabilization significantly increased range of motion in all directions compared with the intact status (P < 0.001). However, after EFR of the transverse ligament, range of motion in all directions was restored to the intact state. Meanwhile, coupling motions were reproduced in the axial rotation.ConclusionsEFR of the transverse ligament virtually recovers all the physiological functions of the native transverse ligament and might be a promising alternative for the treatment of anterior atlantoaxial dislocation. Further studies are warranted before clinical application of EFR of the transverse ligament.Copyright © 2023 Elsevier Inc. All rights reserved.

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