Abstract
Surgery for atlantoaxial instability requires understanding of philosophical concepts apart from clarity of biomechanical and anatomical subtleties. While a successful surgery can result in rapid neurological recovery, any complication can be life-threatening. The fulcrum of all movements in the atlantoaxial region is in the atlantoaxial joint. Opening of the joint, denuding of the articular cartilage, and stuffing of the articular cavity with bone graft are essential components of the operation. Direct implantation of screws into the firm and largely cortical bones of the facets can lead to firm fixation of the region and provide a basis for solid arthrodesis. Manual manipulation of the facet after wide surgical exposure can be a useful surgical maneuver. Atlantoaxial joint can be unstable (central or axial instability) without any alteration in atlantodental interval or evidence of dura or cord compression. Understanding of this fact can revolutionize the scope of atlantoaxial fixation surgery.
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