Der Orthopäde
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The transoral approach to the upper cervical spine and the respective neuraxis has been recognized for almost 100 years, but it is still not in common use. Based on over 200 operations on patients with a variety of lesions and an age range from 2 1/2 to 83 years, we outline the pathological mechanism, surgical anatomy, indications for surgery, preoperative investigations, variations and extensions of the transoral approach to the upper cervical spine, neuraxis and skull base. The most common post-traumatic lesions and the most frequent tumors are discussed and the recommended surgical approach is described. Surgical techniques, possible complications and their management, as well as postoperative care, are listed.
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Fresh human cadaveric specimens of occiput (C0) to C3 were subjected to 1.5 nm of flexion, extension and bilateral bending and axial torque. The resulting physiological motions were studied in an unconstrained three-dimensional manner. The effects of sequential transections of the left and right alar ligaments on the relative motion of C0-1 and C1-2 were studied. ⋯ In axial rotation, changes in the total motion of the C0-2 joint complex were more reliable indicators. For left alar transsection, most increases were in right axial rotation, e.g., 25.6% for right rotation versus 11.2% for left rotation in the NZ parameter. Functional loss of the alar ligaments indicates a potential for instability which, however, must be determined in conjunction with other clinical findings, such as neurological dysfunction, pain and deformity.