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Acta Neurochir Suppl. 2019;125:71-78. doi: 10.1007/978-3-319-62515-7_11.

Role of Subaxial Spinal and Atlantoaxial Instability in Multisegmental Cervical Spondylotic Myelopathy.

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Department of Neurosurgery, Seth GS Medical College and KEM Hospital, Mumbai, India.



In this paper the role of atlantoaxial and multilevel subaxial spinal instability as the primary nodal point of the pathogenesis of degenerative cervical spinal disease-related myelopathy, and the focus of surgical treatment for it, is evaluated.


The series analyses the treatment of 73 patients with single or multilevel degenerative cervical spinal disease by fixation of the involved spinal segment(s) alone, aimed at arthrodesis. No bone decompression or disc/osteophyte resection was done. In 23 patients, the atlantoaxial joint was included in the spinal fixation, as atlantoaxial instability was identified by facetal malalignment on imaging or by observations on direct bone manipulation during surgery. There were 70 males and 3 females. The ages of the patients ranged from 35 to 76 years (average 57 years). The transarticular screw method was deployed for subaxial spinal fixation and a lateral mass plate/rod and screw technique was used for atlantoaxial fixation.


During the follow-up period, which ranged from 3 to 42 months (average 27 months), all patients improved in terms of their clinical symptoms. There were no surgery- or implant-related complications.


Atlantoaxial joint instability is frequently associated with subaxial multilevel spinal instability in degenerative spinal disease. Fixation of the spinal segments provides a safe, effective and rational treatment for single or multilevel spinal degeneration.


Atlantoaxial instability; Cervical myelopathy; Degeneration; Subaxial spinal instability

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