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Posterior Atlanto-Axial Arthrodesis

- Indications:
    - displaced type II dens frx;
          - note that if posterior C1-C2 fusion is begin considered for type II dens frx, it is important to ensure that there is not a 
                concomitant C1 arch frx;

- Anatomy:
    - vertebral arteries:
          - travel thru the transverse foramen of the atlas, pass along the superior surface of the posterior arch, and finally enter the foramen 
          - the safe zone of dissection lies 1.5 cm from the midline of the atlas;
    - greater occiptal nerve:
          - passes thru the C1-C2 interval, and innervates the posteiror scalp;

- Gallie Technique:
    - most frequently used method to obtain fusion of 1st & 2nd cervical segments;
    - construct is to use bone graft that is shaped to fit astride spine of Axis and is curved to fit the posterior arch of Atlas;
    - this technique avoids sub-laminar wiring;

- Brooks and Jenkins Technique:
    - provides good immediate postoperative stability;
    - it is performed by passing wires under arch of both Atlas & Axis & twisting wires over two wedges of corticocancellous bone that are
          placed between the posterior elements of the Atlas and the Axis;
    - these procedures may be performed while pt is in halo after reduction of the displacement;
    - ref:
          - Atlanto-axial arthrodesis by the wedge compression method.

A biomechanical analysis of atlantoaxial stabilization methods using a bovine model. C1/C2 fixation analysis.

Atlanto-axial fusion with transarticular screw fixation.

Atlanto-axial arthrodesis by the wedge compression method.

Fusion of the upper cervical spine in children and adolescents. An analysis of 17 patients.

Complications of fusion to the upper cervical spine.

Bone graft translation oof four upper cervical spine fixation techniques in a cadaveric model.