• P L Grundy and S S Gill.
• Department of Neurosurgery, Frenchay Hospital, Bristol, England.
• Neurosurgery. 1998 Dec 1; 43 (6): 1483-6; discussion 1486-7.

Objective And ImportanceTo demonstrate a new posterior approach to the anterior elements of the atlas and the axis including the odontoid process.Clinical PresentationA 36-year-old woman presented with ankylosing spondylitis and severe flexion deformity of the cervical spine. She had sustained a trauma 5 years previously, causing the inability to look forward or to open the jaw adequately. An examination demonstrated fixed flexion and rotation of the cervical spine, with no neurological deficit. Radiologically, there was fusion of C1, C2, and the clivus.TechniqueThe upper cervical vertebrae were exposed via a midline posterior incision, the posterior arch of C1 was excised, and the vertebral arteries were mobilized. A wedge osteotomy was performed through the lateral masses of C1 and subsequently through the odontoid. The head was repositioned, and C1-C2 lateral mass screws and a Ransford loop were inserted.ConclusionIt is possible to gain sufficient surgical access to the odontoid process via a posterior approach. The technique described is of benefit when the alternative anterior approaches to the upper cervical spine are technically difficult or impossible.

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