• Atul Goel, Apurva Prasad, Abhidha Shah, and Sandeep More.
• Department of Neurosurgery, Seth G.S. Medical College and K.E.M Hospital, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Mumbai, India. Electronic address: atulgoel62@hotmail.com.
• World Neurosurg. 2018 Feb 1; 110: 604-608.

BackgroundWe present 2 cases involving a previously unreported clinical situation in which basilar invagination, atlantoaxial instability, and C2-3 instability were associated with a bifid posterior arch of the axis bone.Case DescriptionsTwo young males presented with limb weakness, spasticity, and paresthesias. Both patients had altered voice quality, with reduced and thin volume, and difficulty sleeping supine. Radiologic imaging showed an absence of the posterior elements of the C2 vertebrae. The C3 spinous process mimicked the C2 spinous process in shape and size. C1-2 and C2-3 posterior fixations were performed.ConclusionsC1-2 and C2-3 fixation resulted in firm fixation of the region and a remarkable clinical recovery. The most significant features were an immediate postoperative improvement in voice quality and the ability to sleep comfortably in the supine position.Copyright © 2017 Elsevier Inc. All rights reserved.

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