Neurosurgery
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To provide a comprehensive review of the biomechanics, pathophysiology, and clinical management of atlas fractures. ⋯ Atlas fractures can be treated with halo-brace immobilization with acceptable outcomes. The role of surgical fixation, especially for atlas burst fractures, requires further study for clarification.
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A number of anterior approaches to the craniocervical junction have been described to allow exposure to the midline and lateral aspects of both the cranial base and upper cervical spine. The transoral-transpharyngeal approach, a technique that is well known to many spine surgeons, provides surgical access to the anterior clivus, C1, and C2. ⋯ The transoral-transpharyngeal approach remains the "gold standard" for anterior approaches to the cervical spine. Endoscopic endonasal and endoscopic transcervical approaches are promising alternatives that may become more mainstream as experience with these approaches increases.
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An understanding of the regional anatomy and specific biomechanics of the craniovertebral junction is relevant to the specific diseases that affect the region as well as instrumentation of the occiput, atlas, and axis. This article reviews the bony, ligamentous, and vascular anatomy of the region, in relation to the posterior surgical approach to this anatomically unique segment of the cervical spine. ⋯ Basic principles of instrumentation of the region are also reviewed. The kinematics of the region as they pertain to the anatomic discussion are reviewed and discussed.
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Os odontoideum is an independent ossicle of variable size with smooth circumferential cortical margins separated from the foreshortened odontoid peg. The etiology of os odontoideum remains controversial, but there is now emerging consensus on the traumatic etiology of os odontoideum rather than a congenital source. ⋯ There is a role for conservative treatment of an asymptomatic incidentally found, radiologically stable, and noncompressive os odontoideum. Conversely, surgery has a definite role in symptomatic cases. The main method of surgical treatment today is posterior decompression after reduction and fusion via independent C1 and C2 instrumentation. Irreducible, persistent anterior compression from os odontoideum can be approached by a transoral route with good results in experienced hands.
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Comparative Study
Biomechanical comparison of costotransverse process screw fixation and pedicle screw fixation of the upper thoracic spine.
To compare the biomechanics of costotransverse process screw fixation with those of pedicle screw fixation in a cadaveric model of the upper thoracic spine. ⋯ The costotransverse screw technique seems to provide only moderately stiff fixation of the destabilized thoracic spine. Pedicle screw fixation seems to have more favorable biomechanical properties. These data suggest that the costotransverse process construct is better used as a salvage procedure rather than as a primary fixation strategy.