{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T12:05:52Z","timestamp":1753877152370,"version":"3.41.2"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T00:00:00Z","timestamp":1746403200000},"content-version":"vor","delay-in-days":6,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Posterior fixation with fusion is recommended in symptomatic congenital anomalies of the upper cervical spine. Altered vertebral anatomy in such cases increases the likelihood of intraoperative complications, where injury to the vertebral artery (VA) may result in cerebellar and dorsolateral medulla oblongata ischemia. Prompt and appropriate intervention is paramount if complications arise. We present a patient with a dysplastic C1 arch, leading to atlantodental arthrosis and anterior C1 subluxation with resultant compressive myelopathy of the spinal cord. During elective surgery, a VA injury occurred, which was managed with intravascular intervention and salvage contralateral posterior unilateral C1-C2 fusion. Postoperatively, the patient developed partial Wallenberg syndrome. Imaging revealed two ischemic changes in the cerebellar hemisphere. One year after surgery, the patient showed substantial improvement following comprehensive rehabilitation, able to ambulate without support and maintain a significant level of independence in everyday activities.<\/jats:p>","DOI":"10.1093\/jscr\/rjaf267","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T20:53:52Z","timestamp":1746478432000},"source":"Crossref","is-referenced-by-count":0,"title":["Posterior C1-C2 fixation for atlantoaxial instability due to a dysplastic C1 arch, complicated by an accidental vertebral artery injury managed with intravascular intervention and salvage contralateral unilateral fusion"],"prefix":"10.1093","volume":"2025","author":[{"given":"Armand Dominik","family":"\u0160kapin","sequence":"first","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana , Vrazov trg 2, Ljubljana 1000 ,","place":["Slovenia"]},{"name":"Department of Orthopaedic Surgery, University Medical Centre Ljubljana , Zalo\u0161ka 9, Ljubljana 1000 ,","place":["Slovenia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter","family":"Brumat","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana , Vrazov trg 2, Ljubljana 1000 ,","place":["Slovenia"]},{"name":"Department of Orthopaedic Surgery, University Medical Centre Ljubljana , Zalo\u0161ka 9, Ljubljana 1000 ,","place":["Slovenia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ju\u0161","family":"K\u0161ela","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana , Vrazov trg 2, Ljubljana 1000 ,","place":["Slovenia"]},{"name":"Department of Cardiovascular Surgery, University Medical Centre Ljubljana , Zalo\u0161ka 7, Ljubljana 1000 ,","place":["Slovenia"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miha","family":"Vodi\u010dar","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ljubljana , Vrazov trg 2, Ljubljana 1000 ,","place":["Slovenia"]},{"name":"Department of Orthopaedic Surgery, University Medical Centre Ljubljana , Zalo\u0161ka 9, Ljubljana 1000 ,","place":["Slovenia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"key":"2025050516534542100_ref1","doi-asserted-by":"publisher","first-page":"1266","DOI":"10.1007\/s00586-017-5283-4","article-title":"The prevalence of congenital C1 arch anomalies","volume":"27","author":"Hyun","year":"2018","journal-title":"Eur Spine J"},{"key":"2025050516534542100_ref2","doi-asserted-by":"publisher","first-page":"96","DOI":"10.4055\/cios.2014.6.1.96","article-title":"Congenital anomaly of the atlas misdiagnosed as posterior arch fracture of the atlas and atlantoaxial subluxation","volume":"6","author":"Park","year":"2014","journal-title":"Clin Orthop Surg"},{"key":"2025050516534542100_ref3","first-page":"385","article-title":"Complications of anterior and posterior cervical spine surgery. Asian","volume":"10","author":"Cheung","year":"2016","journal-title":"Spine J"},{"key":"2025050516534542100_ref4","first-page":"97","article-title":"Congenital hypoplasia of the posterior arch of the atlas: case report and extensive review of the literature","volume":"21","author":"Sabuncuoglu","year":"2011","journal-title":"Turk Neurosurg"},{"key":"2025050516534542100_ref5","doi-asserted-by":"publisher","first-page":"176","DOI":"10.4103\/0974-8237.147090","article-title":"Complete absence of the posterior arch of C1: case report","volume":"5","author":"Khanna","year":"2014","journal-title":"J Craniovertebr Junction Spine"},{"key":"2025050516534542100_ref6","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1038\/s41582-019-0303-0","article-title":"Degenerative cervical myelopathy - update and future directions","volume":"16","author":"Badhiwala","year":"2020","journal-title":"Nat Rev Neurol"},{"key":"2025050516534542100_ref7","doi-asserted-by":"publisher","first-page":"83","DOI":"10.4103\/jcvjs.jcvjs_116_23","article-title":"An institutional study on accuracy of freehand cervical C1 C2 screws placement by knock and drill technique in craniovertebral anomalous bony anatomy: an evaluation of more than 600 screws based on SGPGI screw accuracy criteria","volume":"15","author":"Sasapardhi","year":"2024","journal-title":"J Craniovertebr Junction Spine"},{"key":"2025050516534542100_ref8","doi-asserted-by":"publisher","first-page":"241","DOI":"10.4103\/jcvjs.jcvjs_36_24","article-title":"Perioperative complications associated with fluoroscopy C1 lateral mass screw fixation (Goel technique) versus computed tomography-guided navigation technique: a review of 202 cases from the German spine registry (DWG-register)","volume":"15","author":"Vinas-Rios","year":"2024","journal-title":"J Craniovertebr Junction Spine"},{"key":"2025050516534542100_ref9","doi-asserted-by":"publisher","first-page":"1619","DOI":"10.3233\/THC-220721","article-title":"Comparison of the clinical efficacy of unilateral and bilateral pedicle screw short-segment fixation and fusion in the treatment of atlantoaxial fracture-dislocation","volume":"31","author":"Ma","year":"2023","journal-title":"Technol Health Care"},{"key":"2025050516534542100_ref10","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1749-799X-9-2","article-title":"Unilateral instrumented fixation for cervical dumbbell tumors","volume":"9","author":"Ando","year":"2014","journal-title":"J Orthopaedic Surg Res"},{"key":"2025050516534542100_ref11","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.CC.22.00603","article-title":"Unilateral C1-C2 posterior fusion in a patient with right vertebral artery anomaly with intracanal trajectory: a case report","volume":"14","author":"Sharma","year":"2024","journal-title":"JBJS Case Connect"},{"key":"2025050516534542100_ref12","doi-asserted-by":"publisher","first-page":"S362","DOI":"10.4103\/2152-7806.120777","article-title":"Vertebral artery injuries in cervical spine surgery","volume":"4","author":"Schroeder","year":"2013","journal-title":"Surg Neurol Int"},{"key":"2025050516534542100_ref13","doi-asserted-by":"crossref","first-page":"E891","DOI":"10.1097\/01.brs.0000244614.84685.c2","article-title":"Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature","volume":"31","author":"Choi","year":"2006","journal-title":"Spine (Phila Pa 1976)"}],"container-title":["Journal of Surgical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/5\/rjaf267\/63056255\/rjaf267.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jscr\/article-pdf\/2025\/5\/rjaf267\/63056255\/rjaf267.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T20:53:53Z","timestamp":1746478433000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jscr\/article\/doi\/10.1093\/jscr\/rjaf267\/8125216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,29]]},"references-count":13,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,4,29]]}},"URL":"https:\/\/doi.org\/10.1093\/jscr\/rjaf267","relation":{},"ISSN":["2042-8812"],"issn-type":[{"type":"electronic","value":"2042-8812"}],"subject":[],"published-other":{"date-parts":[[2025,5]]},"published":{"date-parts":[[2025,4,29]]},"article-number":"rjaf267"}}