{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T20:42:23Z","timestamp":1771706543111,"version":"3.50.1"},"reference-count":33,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Gunshot wounds to the atlantoaxial spine are uncommon injuries and rarely require treatment, as a bullet traversing this segment often results in a fatal injury. Additionally, these injuries are typically biomechanically stable. The authors report a series of 10 patients with gunshot wounds involving the lateral mass and\/or bodies of the atlantoaxial complex. Their care is discussed and conclusions are drawn from these cases to identify the optimal treatment for these injuries.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>A retrospective review was conducted of patients presenting to the emergency rooms of 3 institutions with gunshot wounds involving the atlantoaxial spine. Mechanism of injury and neurological status were obtained, as was the extent of the osteoligamentous, vascular, and neurological injuries. Nonoperative and operative treatment, complications, and clinical and radiographic outcome were recorded. The data were then analyzed to determine the neurological and biomechanical prognosis of these injuries, the utility of the various diagnostic modalities in the acute management of the injuries, and the nature and effectiveness of the nonoperative and operative treatment modalities.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Ten patients with gunshot wounds involving the lateral mass and\/or bodies of the atlantoaxial complex were identified. All but 2 patients sustained a vertebral artery injury. Each patient was evaluated using cervical radiographs, CT scans, and vascular imaging, 8 in the form of digital subtraction angiography and 2 with high-resolution CT angiography. Uncomplicated patients were treated conservatively using cervical collar immobilization, local wound care, and antibiotics. One patient was treated using a halo for instability and 1 underwent posterior fusion following a posterolateral decompression for delayed myelopathy. One patient underwent transoral resection of a bullet fragment. One patient underwent embolization for a symptomatic arteriovenous fistula and a second patient underwent a neck exploration and a jugular vein ligation. None of the patients received anticoagulation therapy. The mean follow-up duration was 13 months. All but 2 patients regained their previous functional status and all ultimately attained a mechanically stable spine.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>These 10 patients represent a rare form of cervical spine penetrating injury. Unilateral gunshot wounds to the atlantoaxial complex are usually stable and the need for acute surgical intervention is rare. Unilateral vertebral artery injury is well tolerated and any information provided by angiography does not alter the acute management of the patient. Vascular complications from gunshot wounds can be managed effectively by endovascular techniques.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.8.spine12907","type":"journal-article","created":{"date-parts":[[2013,9,20]],"date-time":"2013-09-20T13:59:57Z","timestamp":1379685597000},"page":"759-766","source":"Crossref","is-referenced-by-count":16,"title":["Civilian gunshot wounds to the atlantoaxial spine: a report of 10 cases treated using a multidisciplinary approach"],"prefix":"10.3171","volume":"19","author":[{"given":"Peter","family":"Syre","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leonardo","family":"Rodriguez-Cruz","sequence":"additional","affiliation":[{"name":"Cumberland Spine and Neurosurgery, Cookeville, Tennessee;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rajiv","family":"Desai","sequence":"additional","affiliation":[{"name":"Maine Medical Partners Neurosurgery and Spine, Scarborough, Maine;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl A.","family":"Greene","sequence":"additional","affiliation":[{"name":"NeuroSpine Center of Wisconsin, Appleton, Wisconsin; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Hurst","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;"},{"name":"Division of Neuroradiology, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Schuster","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neil R.","family":"Malhotra","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Marcotte","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-spine12907","series-title":"Radiol Clin North Am","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.rcl.2005.08.004","article-title":"Imaging of spinal trauma","volume":"44","author":"Bagley","year":"2006"},{"key":"b2-spine12907","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1227\/00006123-198702000-00014","article-title":"Civilian gunshot wounds to the spinal cord and cauda equina","volume":"20","author":"Benzel","year":"1987"},{"key":"b3-spine12907","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1016\/S1529-9430(03)00178-5","article-title":"Gunshot wounds to the spine","volume":"4","author":"Bono","year":"2004"},{"key":"b4-spine12907","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.surneu.2004.11.029","article-title":"Endovascular management of exsanguinating vertebral artery transection","volume":"64","author":"Cohen","year":"2005"},{"key":"b5-spine12907","series-title":"Turk Neurosurg","first-page":"413","article-title":"Vertebral artery insult at the transverse foramina by gun shot wounds: report of two cases","volume":"19","author":"Dalgic","year":"2009"},{"key":"b6-spine12907","series-title":"Br J Surg","first-page":"83","article-title":"Management options in vertebral artery injuries","volume":"83","author":"Demetriades","year":"1996"},{"key":"b7-spine12907","series-title":"J Trauma","doi-asserted-by":"publisher","first-page":"758","DOI":"10.1097\/00005373-199605000-00012","article-title":"Transcervical gunshot injuries: mandatory operation is not necessary","volume":"40","author":"Demetriades","year":"1996"},{"key":"b8-spine12907","series-title":"J Orthop Trauma","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1097\/00005131-198903010-00004","article-title":"Magnetic resonance imaging in the evaluation of a gunshot wound to the cervical spine","volume":"3","author":"Ebraheim","year":"1989"},{"key":"b9-spine12907","series-title":"Laryngoscope","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1288\/00005537-199501000-00005","article-title":"Management of traumatic hypopharyngeal injuries","volume":"105","author":"Fetterman","year":"1995"},{"key":"b10-spine12907","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2552","DOI":"10.1097\/00007632-199411001-00010","article-title":"Repair of vertebral artery injury during anterior cervical decompression","volume":"19","author":"Golfinos","year":"1994"},{"key":"b11-spine12907","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"432","DOI":"10.1016\/0090-3019(95)80086-V","article-title":"Spinal cord missile injuries during the Lebanese civil war","volume":"43","author":"Hammoud","year":"1995"},{"key":"b12-spine12907","series-title":"Neurosurgery","first-page":"576","article-title":"Steroids and gunshot wounds to the spine","volume":"41","author":"Heary","year":"1997"},{"key":"b13-spine12907","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"575","DOI":"10.3171\/jns.1975.42.5.0575","article-title":"Penetrating gunshot wounds of the cervical spine in civilians. 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