{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T19:57:59Z","timestamp":1772827079183,"version":"3.50.1"},"reference-count":50,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Atlantoaxial dislocation (AAD) with axis osseous deformity poses significant surgical challenges, particularly in complex anatomical cases. This study compares the efficacy of 2-screw versus 4-screw occipital-cervical fixation in improving neurological outcomes and reducing complications in patients with AAD and axis deformity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>A retrospective study was conducted on 37 patients with AAD and axis osseous deformity treated at the authors\u2019 institution from 2017 to 2023. The cohort included 19 patients treated with bilateral pars screws and translaminar screws (4-screw group) and 18 patients who received traditional pedicle screw (PS) fixation (2-screw group) prior to the application of 4-screw fixation. Radiographic parameters, including atlanto-dental interval (ADI), distance from the tip of the dens above the Chamberlain line (CL), cervico-medullary angle (CMA), and clivo-axial angle (CAA), were measured using radiography, CT, and MRI. Neurological function was assessed using the Japanese Orthopaedic Association (JOA) score. Data on complications and revision surgical procedures were collected and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Preoperative demographic and clinical characteristics were comparable between groups. Both techniques effectively improved CAA and CMA and reduced CL, but the 4-screw group demonstrated significantly lower ADI postoperatively (p = 0.001) and at the latest follow-up (p = 0.003). Patients in the 4-screw group also showed significantly higher JOA scores at the latest follow-up (p = 0.027), indicating better neurological recovery. The incidence of postoperative complications was lower in the 4-screw group (1 vs 6, p = 0.037), and no revision surgical procedures were required in this group, whereas 4 patients in the 2-screw group required further surgical interventions (p = 0.046).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Four-screw occipital-cervical fixation offers improved neurological functions and fewer postoperative complications compared to 2-screw fixation in patients with AAD and axis osseous deformity. This technique is particularly beneficial in cases with complex axis anatomy, suggesting its potential as a preferred alternative to traditional fixation methods.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2024.11.spine24951","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T21:20:51Z","timestamp":1740777651000},"page":"624-632","source":"Crossref","is-referenced-by-count":0,"title":["Axis 4-screw technique for occipital-cervical fixation in the treatment of atlantoaxial dislocation with axis osseous deformity: a retrospective study with a minimum 1-year follow-up"],"prefix":"10.3171","volume":"42","author":[{"given":"Zhihang","family":"Gan","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nanfang","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shenglin","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yinglun","family":"Tian","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guodong","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shilin","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qiyue","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ye","family":"Ouyang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renyi","family":"Liang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Peking University Third Hospital, Beijing, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"21","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"E1348","article-title":"Novel surgical classification and treatment strategy for atlantoaxial dislocations","volume":"38","author":"Wang S","year":"2013","unstructured":"Wang S, Wang C, Yan M, Zhou H, Dang G. Novel surgical classification and treatment strategy for atlantoaxial dislocations. Spine (Phila Pa 1976). 2013;38(21):E1348\u2013E1356."},{"issue":"10","key":"b2","series-title":"J Bone Joint Surg Am","first-page":"771","article-title":"Clinical and surgical characteristics of patients with atlantoaxial dislocation in the setting of sandwich fusion: a case-control analysis of over 500 patients with mid-term to long-term follow-up","volume":"105","author":"Xu N","year":"2023","unstructured":"Xu N, Tian Y, Yue L,  Clinical and surgical characteristics of patients with atlantoaxial dislocation in the setting of sandwich fusion: a case-control analysis of over 500 patients with mid-term to long-term follow-up. J Bone Joint Surg Am. 2023;105(10):771\u2013778."},{"issue":"10","key":"b3","series-title":"Spine J","first-page":"2271","article-title":"Posterior atlantoaxial fixation: a review of all techniques","volume":"15","author":"Huang DG","year":"2015","unstructured":"Huang DG, Hao DJ, He BR,  Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15(10):2271\u20132281."},{"key":"b4","series-title":"World Neurosurg","first-page":"e458","article-title":"Spinous process screw fixation: a salvage technique in subaxial cervical spinal instrumentation","volume":"154","author":"Tian Y","year":"2021","unstructured":"Tian Y, Xu N, Leng H, Wang S. Spinous process screw fixation: a salvage technique in subaxial cervical spinal instrumentation. World Neurosurg. 2021;154:e458\u2013e464."},{"issue":"10","key":"b5","series-title":"Clin Spine Surg","first-page":"448","article-title":"Pedicle screw combined with lateral mass screw fixation in the treatment of basilar invagination and congenital C2-C3 fusion","volume":"29","author":"Wang S","year":"2016","unstructured":"Wang S, Wang C, Leng H, Zhao W, Yan M, Zhou H. Pedicle screw combined with lateral mass screw fixation in the treatment of basilar invagination and congenital C2-C3 fusion. Clin Spine Surg. 2016;29(10):448\u2013453."},{"issue":"8","key":"b6","series-title":"Eur Spine J","first-page":"1306","article-title":"Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2-3 fusion patients?","volume":"19","author":"Wang S","year":"2010","unstructured":"Wang S, Wang C, Passias PG, Yan M, Zhou H. Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2-3 fusion patients? Eur Spine J. 2010;19(8):1306\u20131311."},{"key":"b7","series-title":"World Neurosurg","first-page":"e1511","article-title":"Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws","volume":"122","author":"Wang Y","year":"2019","unstructured":"Wang Y, Wang C, Yan M. Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws. World Neurosurg. 2019;122:e1511\u2013e1518."},{"key":"b8","series-title":"World Neurosurg","first-page":"38","article-title":"4-point C2 fixation for occipitocervical fusion: technical case report","volume":"148","author":"Houten JK","year":"2021","unstructured":"Houten JK, Kinon MD, Weinstein GR. 4-point C2 fixation for occipitocervical fusion: technical case report. World Neurosurg. 2021;148:38\u201343."},{"issue":"5","key":"b9","series-title":"Int J Spine Surg","first-page":"611","article-title":"The four fixation points of the axis: technique and case report","volume":"12","author":"Siemionow K","year":"2018","unstructured":"Siemionow K, Janusz P, Mardjetko S. The four fixation points of the axis: technique and case report. Int J Spine Surg. 2018;12(5):611\u2013616."},{"issue":"6","key":"b10","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy","volume":"40","author":"Furlan JC","year":"2016","unstructured":"Furlan JC, Catharine Craven B. Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy. Neurosurg Focus. 2016;40(6):E6."},{"issue":"5","key":"b11","series-title":"Neurosurgery","first-page":"976","article-title":"Cable-strengthened C2 pedicle screw fixation in the treatment of congenital C2-3 fusion, atlas occipitalization, and atlantoaxial dislocation","volume":"71","author":"Wang S","year":"2012","unstructured":"Wang S, Wang C, Leng H, Zhao W, Yan M, Zhou H. Cable-strengthened C2 pedicle screw fixation in the treatment of congenital C2-3 fusion, atlas occipitalization, and atlantoaxial dislocation. Neurosurgery. 2012;71(5):976\u2013984."},{"issue":"1","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"E60","article-title":"Comparison of two posterior three-point fixation techniques for treating reducible atlantoaxial dislocation","volume":"44","author":"Zhao W","year":"2019","unstructured":"Zhao W, Wu Y, Hu W,  Comparison of two posterior three-point fixation techniques for treating reducible atlantoaxial dislocation. Spine (Phila Pa 1976). 2019;44(1):E60\u2013E66."},{"issue":"1","key":"b13","series-title":"BMC Musculoskelet Disord","first-page":"307","article-title":"Outcomes of occipitocervical fixation using a spinous process screw in C2 as a third anchor point for occipitocervical fixation: a case presentation","volume":"21","author":"Liu G","year":"2020","unstructured":"Liu G, Li Q, Sheng F,  Outcomes of occipitocervical fixation using a spinous process screw in C2 as a third anchor point for occipitocervical fixation: a case presentation. BMC Musculoskelet Disord. 2020;21(1):307."},{"issue":"5","key":"b14","series-title":"Global Spine J","first-page":"647","article-title":"Occipitocervical fixation: general considerations and surgical technique","volume":"10","author":"Joaquim AF","year":"2020","unstructured":"Joaquim AF, Osorio JA, Riew KD. Occipitocervical fixation: general considerations and surgical technique. Global Spine J. 2020;10(5):647\u2013656."},{"issue":"4","key":"b15","series-title":"Neurosurgery","first-page":"549","article-title":"Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients","volume":"79","author":"Martinez-Del-Campo E","year":"2016","unstructured":"Martinez-Del-Campo E, Turner JD, Kalb S,  Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients. Neurosurgery. 2016;79(4):549\u2013560."},{"issue":"6","key":"b16","series-title":"Neurosurgery","first-page":"1148","article-title":"Biomechanical implications of extending occipitocervical instrumentation to include the subaxial spine","volume":"66","author":"Martin MD","year":"2010","unstructured":"Martin MD, Bruner HJ, Wolfla CE, Yoganandan N. Biomechanical implications of extending occipitocervical instrumentation to include the subaxial spine. Neurosurgery. 2010;66(6):1148\u20131152."},{"key":"b17","series-title":"World Neurosurg","first-page":"621.e1","article-title":"Congenital spondylolytic spondylolisthesis of C2 vertebra associated with atlanto-axial dislocation, Chiari type I malformation, and anomalous vertebral artery: case report with review literature","volume":"95","author":"Sardhara J","year":"2016","unstructured":"Sardhara J, Pavaman S, Das K, Srivastava A, Mehrotra A, Behari S. Congenital spondylolytic spondylolisthesis of C2 vertebra associated with atlanto-axial dislocation, Chiari type I malformation, and anomalous vertebral artery: case report with review literature. World Neurosurg. 2016;95:621.e1\u2013621.e5."},{"key":"b18","series-title":"Clin Neurol Neurosurg","first-page":"134","article-title":"Occipitocervical fusion: fix to C2 or C3?","volume":"127","author":"Pan J","year":"2014","unstructured":"Pan J, Huang D, Hao D,  Occipitocervical fusion: fix to C2 or C3? Clin Neurol Neurosurg. 2014;127:134\u2013139."},{"issue":"37","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e1492","article-title":"Feasibility of C2 vertebra screws placement in patient with occipitalization of atlas: a tomographic study","volume":"94","author":"Ji W","year":"2015","unstructured":"Ji W, Liu X, Huang W,  Feasibility of C2 vertebra screws placement in patient with occipitalization of atlas: a tomographic study. Medicine (Baltimore). 2015;94(37):e1492."},{"issue":"5)(suppl 2","key":"b20","series-title":"Neurosurgery","first-page":"343","article-title":"Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws","volume":"64","author":"Parker SL","year":"2009","unstructured":"Parker SL, McGirt MJ, Garc\u00e9s-Ambrossi GL,  Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws. Neurosurgery. 2009;64(5)(suppl 2):343\u2013349."},{"issue":"4","key":"b21","series-title":"Neurospine","first-page":"899","article-title":"Characteristics and comparisons of morphometric measurements and computed tomography Hounsfield unit values of C2 laminae for translaminar screw placement between patients with and without basilar invagination","volume":"19","author":"Zhou LP","year":"2022","unstructured":"Zhou LP, Shang J, Zhang ZG,  Characteristics and comparisons of morphometric measurements and computed tomography Hounsfield unit values of C2 laminae for translaminar screw placement between patients with and without basilar invagination. Neurospine. 2022;19(4):899\u2013911."},{"key":"b22","series-title":"World Neurosurg","first-page":"e1166","article-title":"A novel construct incorporating C2 unilateral pedicle and contralateral translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study","volume":"149","author":"Huang J","year":"2021","unstructured":"Huang J, Wang X, Nie Q, Zhang C, Wu H, Jian F. A novel construct incorporating C2 unilateral pedicle and contralateral translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study. World Neurosurg. 2021;149:e1166\u2013e1173."},{"issue":"2","key":"b23","series-title":"Eur Spine J","first-page":"362","article-title":"Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability","volume":"28","author":"Shi L","year":"2019","unstructured":"Shi L, Shen K, Deng R,  Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability. Eur Spine J. 2019;28(2):362\u2013369."},{"issue":"2","key":"b24","series-title":"J Neurosurg Spine","first-page":"135","article-title":"Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques","volume":"29","author":"Wang S","year":"2018","unstructured":"Wang S, Tian Y, Diebo BG, Horn SR, Passias PG. Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques. J Neurosurg Spine. 2018;29(2):135\u2013143."},{"issue":"5","key":"b25","series-title":"Acta Neurochir (Wien)","first-page":"1155","article-title":"Strategies to avoid internal carotid artery injury in \"sandwich\" atlantoaxial dislocation patients during surgery","volume":"165","author":"Tian Y","year":"2023","unstructured":"Tian Y, Xu N, Yan M,  Strategies to avoid internal carotid artery injury in \"sandwich\" atlantoaxial dislocation patients during surgery. Acta Neurochir (Wien). 2023;165(5):1155\u20131160."},{"issue":"21","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"E1348","article-title":"Novel surgical classification and treatment strategy for atlantoaxial dislocations","volume":"38","author":"Wang S","year":"2013","unstructured":"Wang S, Wang C, Yan M, Zhou H, Dang G. Novel surgical classification and treatment strategy for atlantoaxial dislocations. Spine (Phila Pa 1976). 2013;38(21):E1348\u2013E1356."},{"issue":"10","key":"b2","series-title":"J Bone Joint Surg Am","first-page":"771","article-title":"Clinical and surgical characteristics of patients with atlantoaxial dislocation in the setting of sandwich fusion: a case-control analysis of over 500 patients with mid-term to long-term follow-up","volume":"105","author":"Xu N","year":"2023","unstructured":"Xu N, Tian Y, Yue L,  Clinical and surgical characteristics of patients with atlantoaxial dislocation in the setting of sandwich fusion: a case-control analysis of over 500 patients with mid-term to long-term follow-up. J Bone Joint Surg Am. 2023;105(10):771\u2013778."},{"issue":"10","key":"b3","series-title":"Spine J","first-page":"2271","article-title":"Posterior atlantoaxial fixation: a review of all techniques","volume":"15","author":"Huang DG","year":"2015","unstructured":"Huang DG, Hao DJ, He BR,  Posterior atlantoaxial fixation: a review of all techniques. Spine J. 2015;15(10):2271\u20132281."},{"key":"b4","series-title":"World Neurosurg","first-page":"e458","article-title":"Spinous process screw fixation: a salvage technique in subaxial cervical spinal instrumentation","volume":"154","author":"Tian Y","year":"2021","unstructured":"Tian Y, Xu N, Leng H, Wang S. Spinous process screw fixation: a salvage technique in subaxial cervical spinal instrumentation. World Neurosurg. 2021;154:e458\u2013e464."},{"issue":"10","key":"b5","series-title":"Clin Spine Surg","first-page":"448","article-title":"Pedicle screw combined with lateral mass screw fixation in the treatment of basilar invagination and congenital C2-C3 fusion","volume":"29","author":"Wang S","year":"2016","unstructured":"Wang S, Wang C, Leng H, Zhao W, Yan M, Zhou H. Pedicle screw combined with lateral mass screw fixation in the treatment of basilar invagination and congenital C2-C3 fusion. Clin Spine Surg. 2016;29(10):448\u2013453."},{"issue":"8","key":"b6","series-title":"Eur Spine J","first-page":"1306","article-title":"Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2-3 fusion patients?","volume":"19","author":"Wang S","year":"2010","unstructured":"Wang S, Wang C, Passias PG, Yan M, Zhou H. Pedicle versus laminar screws: what provides more suitable C2 fixation in congenital C2-3 fusion patients? Eur Spine J. 2010;19(8):1306\u20131311."},{"key":"b7","series-title":"World Neurosurg","first-page":"e1511","article-title":"Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws","volume":"122","author":"Wang Y","year":"2019","unstructured":"Wang Y, Wang C, Yan M. Clinical outcomes of atlantoaxial dislocation combined with high-riding vertebral artery using C2 translaminar screws. World Neurosurg. 2019;122:e1511\u2013e1518."},{"key":"b8","series-title":"World Neurosurg","first-page":"38","article-title":"4-point C2 fixation for occipitocervical fusion: technical case report","volume":"148","author":"Houten JK","year":"2021","unstructured":"Houten JK, Kinon MD, Weinstein GR. 4-point C2 fixation for occipitocervical fusion: technical case report. World Neurosurg. 2021;148:38\u201343."},{"issue":"5","key":"b9","series-title":"Int J Spine Surg","first-page":"611","article-title":"The four fixation points of the axis: technique and case report","volume":"12","author":"Siemionow K","year":"2018","unstructured":"Siemionow K, Janusz P, Mardjetko S. The four fixation points of the axis: technique and case report. Int J Spine Surg. 2018;12(5):611\u2013616."},{"issue":"6","key":"b10","series-title":"Neurosurg Focus","first-page":"E6","article-title":"Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy","volume":"40","author":"Furlan JC","year":"2016","unstructured":"Furlan JC, Catharine Craven B. Psychometric analysis and critical appraisal of the original, revised, and modified versions of the Japanese Orthopaedic Association score in the assessment of patients with cervical spondylotic myelopathy. Neurosurg Focus. 2016;40(6):E6."},{"issue":"5","key":"b11","series-title":"Neurosurgery","first-page":"976","article-title":"Cable-strengthened C2 pedicle screw fixation in the treatment of congenital C2-3 fusion, atlas occipitalization, and atlantoaxial dislocation","volume":"71","author":"Wang S","year":"2012","unstructured":"Wang S, Wang C, Leng H, Zhao W, Yan M, Zhou H. Cable-strengthened C2 pedicle screw fixation in the treatment of congenital C2-3 fusion, atlas occipitalization, and atlantoaxial dislocation. Neurosurgery. 2012;71(5):976\u2013984."},{"issue":"1","key":"b12","series-title":"Spine (Phila Pa 1976)","first-page":"E60","article-title":"Comparison of two posterior three-point fixation techniques for treating reducible atlantoaxial dislocation","volume":"44","author":"Zhao W","year":"2019","unstructured":"Zhao W, Wu Y, Hu W,  Comparison of two posterior three-point fixation techniques for treating reducible atlantoaxial dislocation. Spine (Phila Pa 1976). 2019;44(1):E60\u2013E66."},{"issue":"1","key":"b13","series-title":"BMC Musculoskelet Disord","first-page":"307","article-title":"Outcomes of occipitocervical fixation using a spinous process screw in C2 as a third anchor point for occipitocervical fixation: a case presentation","volume":"21","author":"Liu G","year":"2020","unstructured":"Liu G, Li Q, Sheng F,  Outcomes of occipitocervical fixation using a spinous process screw in C2 as a third anchor point for occipitocervical fixation: a case presentation. BMC Musculoskelet Disord. 2020;21(1):307."},{"issue":"5","key":"b14","series-title":"Global Spine J","first-page":"647","article-title":"Occipitocervical fixation: general considerations and surgical technique","volume":"10","author":"Joaquim AF","year":"2020","unstructured":"Joaquim AF, Osorio JA, Riew KD. Occipitocervical fixation: general considerations and surgical technique. Global Spine J. 2020;10(5):647\u2013656."},{"issue":"4","key":"b15","series-title":"Neurosurgery","first-page":"549","article-title":"Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients","volume":"79","author":"Martinez-Del-Campo E","year":"2016","unstructured":"Martinez-Del-Campo E, Turner JD, Kalb S,  Occipitocervical fixation: a single surgeon\u2019s experience with 120 patients. Neurosurgery. 2016;79(4):549\u2013560."},{"issue":"6","key":"b16","series-title":"Neurosurgery","first-page":"1148","article-title":"Biomechanical implications of extending occipitocervical instrumentation to include the subaxial spine","volume":"66","author":"Martin MD","year":"2010","unstructured":"Martin MD, Bruner HJ, Wolfla CE, Yoganandan N. Biomechanical implications of extending occipitocervical instrumentation to include the subaxial spine. Neurosurgery. 2010;66(6):1148\u20131152."},{"key":"b17","series-title":"World Neurosurg","first-page":"621.e1","article-title":"Congenital spondylolytic spondylolisthesis of C2 vertebra associated with atlanto-axial dislocation, Chiari type I malformation, and anomalous vertebral artery: case report with review literature","volume":"95","author":"Sardhara J","year":"2016","unstructured":"Sardhara J, Pavaman S, Das K, Srivastava A, Mehrotra A, Behari S. Congenital spondylolytic spondylolisthesis of C2 vertebra associated with atlanto-axial dislocation, Chiari type I malformation, and anomalous vertebral artery: case report with review literature. World Neurosurg. 2016;95:621.e1\u2013621.e5."},{"key":"b18","series-title":"Clin Neurol Neurosurg","first-page":"134","article-title":"Occipitocervical fusion: fix to C2 or C3?","volume":"127","author":"Pan J","year":"2014","unstructured":"Pan J, Huang D, Hao D,  Occipitocervical fusion: fix to C2 or C3? Clin Neurol Neurosurg. 2014;127:134\u2013139."},{"issue":"37","key":"b19","series-title":"Medicine (Baltimore)","first-page":"e1492","article-title":"Feasibility of C2 vertebra screws placement in patient with occipitalization of atlas: a tomographic study","volume":"94","author":"Ji W","year":"2015","unstructured":"Ji W, Liu X, Huang W,  Feasibility of C2 vertebra screws placement in patient with occipitalization of atlas: a tomographic study. Medicine (Baltimore). 2015;94(37):e1492."},{"issue":"5)(suppl 2","key":"b20","series-title":"Neurosurgery","first-page":"343","article-title":"Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws","volume":"64","author":"Parker SL","year":"2009","unstructured":"Parker SL, McGirt MJ, Garc\u00e9s-Ambrossi GL,  Translaminar versus pedicle screw fixation of C2: comparison of surgical morbidity and accuracy of 313 consecutive screws. Neurosurgery. 2009;64(5)(suppl 2):343\u2013349."},{"issue":"4","key":"b21","series-title":"Neurospine","first-page":"899","article-title":"Characteristics and comparisons of morphometric measurements and computed tomography Hounsfield unit values of C2 laminae for translaminar screw placement between patients with and without basilar invagination","volume":"19","author":"Zhou LP","year":"2022","unstructured":"Zhou LP, Shang J, Zhang ZG,  Characteristics and comparisons of morphometric measurements and computed tomography Hounsfield unit values of C2 laminae for translaminar screw placement between patients with and without basilar invagination. Neurospine. 2022;19(4):899\u2013911."},{"key":"b22","series-title":"World Neurosurg","first-page":"e1166","article-title":"A novel construct incorporating C2 unilateral pedicle and contralateral translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study","volume":"149","author":"Huang J","year":"2021","unstructured":"Huang J, Wang X, Nie Q, Zhang C, Wu H, Jian F. A novel construct incorporating C2 unilateral pedicle and contralateral translaminar screws for occipitocervical internal fixation: an in vitro biomechanical study. World Neurosurg. 2021;149:e1166\u2013e1173."},{"issue":"2","key":"b23","series-title":"Eur Spine J","first-page":"362","article-title":"Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability","volume":"28","author":"Shi L","year":"2019","unstructured":"Shi L, Shen K, Deng R,  Novel unilateral C1 double screw and ipsilateral C2 pedicle screw placement combined with contralateral laminar screw-rod fixation for atlantoaxial instability. Eur Spine J. 2019;28(2):362\u2013369."},{"issue":"2","key":"b24","series-title":"J Neurosurg Spine","first-page":"135","article-title":"Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques","volume":"29","author":"Wang S","year":"2018","unstructured":"Wang S, Tian Y, Diebo BG, Horn SR, Passias PG. Treatment of atlantoaxial dislocations among patients with cervical osseous or vascular abnormalities utilizing hybrid techniques. J Neurosurg Spine. 2018;29(2):135\u2013143."},{"issue":"5","key":"b25","series-title":"Acta Neurochir (Wien)","first-page":"1155","article-title":"Strategies to avoid internal carotid artery injury in \"sandwich\" atlantoaxial dislocation patients during surgery","volume":"165","author":"Tian Y","year":"2023","unstructured":"Tian Y, Xu N, Yan M,  Strategies to avoid internal carotid artery injury in \"sandwich\" atlantoaxial dislocation patients during surgery. 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