Spine最新文献

{"title":"Basilar Invagination Diagnosis, Classification, and Radiology: WFNS Spine Committee Recommendations.","authors":"Onur Yaman, Mehmet Zileli, İdris Avci, Zan Chen, June Ho Lee, Geraldo Sá-Carneiro, Francesco Costa, Said Ait Ben Ali, Fernando Dantas, Joachim Oertel, Massimiliano Visocchi, Jutty Parthiban, Atul Goel, Ricardo Botelho, Oscar L Alves","doi":"10.1097/BRS.0000000000005308","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005308","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aimed to analyze recent literature on diagnosis, classification, and radiologic characteristics of Basilar Invagination (BI) to generate recommendations on these topics.</p><p><strong>Summary of background: </strong>Basilar invagination diagnosis, classifications, and radiologic characteristics evolved during the last decade; however, many debatable criteria disturb a common language fundamental to compare clinical research.</p><p><strong>Material and methods: </strong>The WFNS Spine Committee organized two separate consensus meetings to discuss and create statements that were voted on to reach a consensus.</p><p><strong>Results: </strong>Basilar invagination mainly results from a CVJ developmental abnormality and is often associated with congenital anomalies. There is also an acquired type that occurs by bone softening, such as rheumatoid arthritis. It can be classified as type I (atlantoaxial dislocation) and type II (without atlantoaxial dislocation) basilar invagination. Clinical signs may either be due to brainstem compression or cervical spinal cord compression and instability. Although many radiologic measurements are proposed, the most reliable ones are the McRae line, Chamberlain line, and Boogard angle.</p><p><strong>Conclusions: </strong>Diagnosis of basilar invagination should be made by midsagittal craniocervical x-rays, CTs or MRI. There are two types of basilar invagination: type I basilar invagination is associated with instability, and treatment can focus on stabilization. However, type II basilar invagination may need decompressive surgeries.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 11","pages":"E200-E207"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143982190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Biomechanical Analysis of Instrumentation Constructs During Vertebral Column Resection: Stability When You Need It!","authors":"K Aaron Shaw, Brad Niese, Daniel J Sucato","doi":"10.1097/BRS.0000000000005198","DOIUrl":"10.1097/BRS.0000000000005198","url":null,"abstract":"<p><strong>Study design: </strong>Biomechanical testing.</p><p><strong>Objective: </strong>Investigate the optimal construct for stabilization of the spine during vertebral column resection (VCR).</p><p><strong>Background: </strong>VCR is a powerful technique for achieving correction in severe cases of spinal deformity. However, this also creates an unstable spine, which requires stable fixation to prevent iatrogenic neurological injury. It is common practice to place a temporary unilateral rod configuration to achieve this stability during surgery but no study to date has investigated the optimal construct configuration.</p><p><strong>Materials and methods: </strong>A unilateral VCR model representing an acute 50° kyphotic deformity with a standardized 30 mm resection was created. Three conditions underwent testing: (1) Rod material and diameter, (2) Rod configuration, and (3) Number of fixation points. Six unique samples were tested in each group in both flexion and extension. Before testing, a 10N preload and underwent cyclical testing in flexion/extension. System stiffness was calculated and compared across groups.</p><p><strong>Results: </strong>Assessment of rod size and composition using a single screw construct (2 total screws) demonstrated that for titanium rods, increasing rod size significantly increased the construct stiffness ( P = 0.001). Although cobalt-chromium (Co-Cr) rods were significantly stiffer than the corresponding sized titanium rods, there was no significant difference between rod diameters for Co-Cr ( P = 0.98). However, when tested using a dual screw (4 total screws) construct, these constructs were significantly stiffer than the corresponding single screw constructs ( P < 0.0001). Of the various rod configurations, the dual rod demonstrated the greatest stiffness (34.8 ± 2.1 N/mm; P < 0.0001).</p><p><strong>Conclusion: </strong>Surgical construct stiffness during a VCR is multifactorial. Larger rod diameter, increased number of fixation points, stiffer rod material, and increased number of rods across the resection site increase the construct stiffness. With minimal points of fixation using Co-Cr rods, increasing rod diameter does not impart greater construct stiffness unless additional fixation points are included.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E219-E222"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142547600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Syndromic Atlanto-axial Instability: WFNS Consensus on Screening and Surveillance, Sports Clearance, and Treatment Options.","authors":"Joachim Oertel, Gustavo Uriza, Karen Radtke, June Ho Lee, Francesco Costa, Fernando Dantas, Salman Sharif, Jutty Parthiban, Massimiliano Visocchi, Jörg Klekamp, Mehmet Zileli, Ricardo Botelho, Óscar L Alves","doi":"10.1097/BRS.0000000000005291","DOIUrl":"10.1097/BRS.0000000000005291","url":null,"abstract":"<p><strong>Study design: </strong>Systematic review plus expert opinion framed on Delphi Method.</p><p><strong>Objective: </strong>Define criteria to on (i) how to screen for instability of cranio-vertebral CVJ in a high-risk population, especially in Down or Morquio syndrome, (ii) if or when which surgical procedure is indicated, and (iii) whether syndromic patients can safely participate in sports activities.</p><p><strong>Summary background data: </strong>Syndromic abnormalities of CVJ may lead to potentially devastating neurological deficits. As of now, there is no international consensus on how to handle syndromic patients with atlanto-axial instability.</p><p><strong>Methods: </strong>International spine specialists of the WFNS spine committee reviewed statements from articles published between 2012 and 2022 to reach an expert agreement. Each statement was voted for on a Likert scale. The Delphi method was used to achieve a high level of validity.</p><p><strong>Results: </strong>Because of the high incidence of craniovertebral instability in Down's patients, close neurological and radiologic screening is advocated. In Morquio's patients older than 5 years, it is recommended to perform an annual neurological examination and imaging studies to detect cervical stenosis or instability. For atlanto-axial instability (AAI), the recommended screening should include cervical spine lateral radiograph in controlled flexion/extension projections. In asymptomatic Down and Morquio syndrome patients with proven AAI, preventive stabilization might be considered. Neurological symptoms deriving from AAI are an indication for stabilization through Goel-Harms C1-C2 technique.Patients without AAI and intact neurological status are cleared to unrestricted sports. Down syndrome patients with symptoms but without AAI or spinal cord compression can participate in most Special Olympics sports competition activities.</p><p><strong>Conclusions: </strong>Consent was achieved on treatment recommendations for patients with syndromic disorders of the CVJ, with special focus laid on participation in physical activity and sports competitions. This should help spine surgeons and sports medicine doctors decide on a management path for each individual patient.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"779-785"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and Management of Basilar Invagination With Associated Chiari I Malformation: WFNS Spine Committee Recommendations.","authors":"Jörg Klekamp, Oscar L Alves, Mehmet Zileli, Joachim Oertel, Onur Yaman, Salman Sharif, Massimiliano Visocchi, Atul Goel, Ricardo Botelho","doi":"10.1097/BRS.0000000000005293","DOIUrl":"10.1097/BRS.0000000000005293","url":null,"abstract":"<p><strong>Study design: </strong>Systematic literature review plus expert opinion framed on Delphi method.</p><p><strong>Objective: </strong>To analyze the influence of coexistent Chiari I malformation (CMI) on the management of basilar invagination (BI).</p><p><strong>Summary of background data: </strong>Basilar invagination (BI) and Chiari 1 malformation (CMI) constitute the commonest anomalies of the craniovertebral junction (CVJ). Treatment becomes even more challenging for patients in whom both pathologies coexist.</p><p><strong>Materials and methods: </strong>Using PubMed, the authors identified 48 publications published between 2011 and 2022 concerning the incidence and management of both pathologies in combination. By means of the Delphi method, a panel of expert spine surgeons analyzed the strength of the published literature and voted statements concerning the management of BI combined with CMI.</p><p><strong>Results: </strong>The incidence for a combination of BI with CMI is estimated between 2.4/100,000 in children and 9.6 to 19.7/100,000 in adults. BI with ventral compression of the medulla related to AAD can be treated in a single operation by sagittal realignment through C1-C2 facet joint distraction and fusion. In the event of unreducible BI, insufficient ventral decompression by C1/2 fusion alone may be overcome by adding a foramen magnum decompression to allow posterior shift of the medulla. BI patients with concomitant CMI have an undersized posterior fossa volume. This implies that surgical treatment of BI combined with CMI has either to increase posterior fossa volume or to include a posterior decompression.</p><p><strong>Conclusion: </strong>In patients with BI, concomitant CMI is a modifier of surgical management. In BI with AAD, an additional foramen magnum decompression should be added to posterior C1-C2 realignment and fusion. In BI without AAD, whether treatment is restricted to FMD or C1/2 fusion is required on top or alternatively, demands further studies. Odontoid resections are reserved for patients with insufficient alignment after posterior surgery.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"786-791"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Delayed Clinical Benefit Following Surgical Treatment for Low-grade Spondylolisthesis.","authors":"Mladen Djurasovic, Leah Y Carreon, Erica F Bisson, Andrew K Chan, Mohamad Bydon, Praveen V Mummaneni, Kevin T Foley, Christopher I Shaffrey, Eric A Potts, Mark E Shaffrey, Domagoj Coric, John J Knightly, Paul Park, Michael Y Wang, Kai-Ming Fu, Jonathan R Slotkin, Anthony L Asher, Michael S Virk, Dean Chou, Regis W Haid, Steven D Glassman","doi":"10.1097/BRS.0000000000005115","DOIUrl":"10.1097/BRS.0000000000005115","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective review of prospectively collected data.</p><p><strong>Objective: </strong>The aim of this study was to investigate what factors predict delayed improvement after surgical treatment of low-grade spondylolisthesis.</p><p><strong>Summary of background data: </strong>Lumbar surgery leads to clinical improvement in the majority of patients with low-grade spondylolisthesis. Most patients improve rapidly after surgery, but some patients demonstrate a delayed clinical course.</p><p><strong>Methods: </strong>The Quality and Outcomes Database (QOD) was queried for grade 1 spondylolisthesis patients who underwent surgery who had patient-reported outcome measures (PROMs) collected at baseline, 3, 6, and 12 months, including back and leg pain Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), and EuroQol-5D (EQ-5D). Patients were stratified as \"early responders\" reaching MCID at 3 months and maintaining improvement through 12 months and \"delayed responders\" not reaching MCID at 3 months but ultimately reaching MCID at 12 months. These two groups were compared with respect to factors which predicted delayed improvement.</p><p><strong>Results: </strong>Of 608 patients enrolled, 436 (72%) met inclusion criteria for this study. Overall, 317 patients (72.7%) reached MCID for ODI at 12 months following surgery. Of these patients, 249 (78.5%) exhibited a rapid clinical improvement trajectory and had achieved ODI MCID threshold by the 3-month postoperative follow-up. Sixty-eight patients (21.4%) showed a delayed trajectory, and had not achieved ODI MCID threshold at 3 months, but did ultimately reach MCID at 12-month follow-up. Factors associated with delayed improvement included impaired preoperative ambulatory status, better baseline back and leg pain scores, and worse 3-month leg pain scores ( P <0.01).</p><p><strong>Conclusions: </strong>The majority of patients undergoing surgery for low-grade spondylolisthesis reach ODI MCID threshold rapidly, within the first 3 months after surgery. Factors associated with a delayed clinical course include impaired preoperative ambulation status, relatively better preoperative back and leg pain, and persistent leg pain at 3 months.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"E213-E218"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141860953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Craniovertebral Junction Anomalies: World Federation of Neurosurgical Societies Spine Committee Recommendations Overview.","authors":"Óscar L Alves, Mehmet Zileli, Salman Sharif, Ricardo Botelho","doi":"10.1097/BRS.0000000000005281","DOIUrl":"10.1097/BRS.0000000000005281","url":null,"abstract":"<p><strong>Objective: </strong>The published literature on craniovertebral junction (CVJ) anomalies lacks a comprehensive appraisal that integrates common diagnostic, management, and treatment concepts for different conditions, such as Chiari malformation (CM), basilar invagination (BI), os odontoideum, and syndromic malformations. The authors aimed to fill this knowledge gap offering guidelines and recommendations with a global outreach and applicability.</p><p><strong>Materials and methods: </strong>A group of expert spine surgeons and World Federation of Neurosurgical Societies Spine Committee members, most of which were extensively published on CVJ anomalies in the past, reviewed the literature issued from 2011 to 2022. Following a common methodology, based on the Delphi method, the authors analyzed the strength of the literature and voted on statements concerning the diagnosis and management of these conditions.</p><p><strong>Results: </strong>A total of 8 papers were produced: (1) CM diagnosis, classifications, natural history, and conservative management, (2) CM: indications for surgery and surgical options, (3) pediatric CM, (4) syndromic atlantoaxial instability, (5) os odontoideum, (6) BI: diagnosis, radiology, and classification, (7) surgical treatment of BI, and (8) BI with associated CM.</p><p><strong>Conclusions: </strong>Despite grey zones on the natural history of CVJ anomalies and controversies on timing and type of surgical treatments, whenever atlantoaxial instability is present, C1 to C2 stabilization through instrumentation and fusion is necessary. If only recurrent pain and neurological dysfunction occur, surgical decompression is appropriate. If no atlantoaxial instability is present, patients with Down syndrome can participate in competitive sports. In general, contact sports are not recommended.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"730-732"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Treatment of Basilar Invagination: WFNS Spine Committee Recommendations.","authors":"Ricardo V Botelho, Oscar L Alves, Geraldo Sá Carneiro, Zan Chen, Onur Yaman, Jutty Parthiban, Massimiliano Visocchi, Jörg Klekamp, Atul Goel, Mehmet Zileli","doi":"10.1097/BRS.0000000000005282","DOIUrl":"10.1097/BRS.0000000000005282","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using Delphi method.</p><p><strong>Objective: </strong>This review aims to outline the therapeutic criteria and clarify the best surgical options for the different types of basilar invagination (BI).</p><p><strong>Summary of background: </strong>BI is a complex developmental malformation for which many surgical remedies have been proposed without clear consensus.</p><p><strong>Materials and methods: </strong>Using PubMed, the authors reviewed the literature on the surgical treatment of BI published from 2011 to 2022 looking at different surgical options. A panel of spine surgeons and members of the WFNS Spine Committee used the Delphi technique to assess the strength of literature, elaborate, and vote on statements regarding the surgical management of BI.</p><p><strong>Results: </strong>Thirteen recommendations were issued covering the most relevant topics related to the surgical treatment of BI. Posterior fossa decompression alone is an option to treat BI without instability. Most cases of BI and AAI can be treated by C1-C2 fixation. In selected cases, distraction of the atlantoaxial joint may be required. Current evidence is lacking which technique is better to correct irreducible BI. OCF can be used in case of atlas assimilation, dysgenesis of C1 lateral mass, in irreducible cases, odontoidectomy and revision of failed C1-C2 fixation. Complications of the OCF may reach up to 50%. The role for anterior fusion for treatment of BI need to be better assessed by further studies. In the setting of irreducible anterior compression caused by BI, the anterior odontoidectomy can be indicated supplemented by C1-C2/occipital-cervical fusion.</p><p><strong>Conclusions: </strong>There are multiple surgical options for basilar invagination depending on the existence of compression, AAD, or irreducibility. The WFNS spine committee proposed consensus recommendations based on relevant literature published after 2011 to help surgeons standardize the level of care and improve outcomes following treatment across the globe.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"751-759"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chiari Malformation: Diagnosis, Classifications, Natural History, and Conservative Management. World Federation of Neurosurgical Societies Spine Committee Recommendations.","authors":"Francesco Costa, Said Ait Benali, Fernando Dantas, Francesco Restelli, Elio Mazzapicchi, Saleh Baeesa, Onur Yaman, Salman Sharif, Oscar L Alves, Mehmet Zileli, Ricardo Botelho","doi":"10.1097/BRS.0000000000005289","DOIUrl":"10.1097/BRS.0000000000005289","url":null,"abstract":"<p><strong>Study design: </strong>A comprehensive search was conducted in PubMed/EMBASE/MEDLINE databases. Inclusion criteria included publications between January 2011 and December 2022 on Chiari malformation (CM) diagnosis classification, natural history, and conservative management.</p><p><strong>Objective: </strong>This study aims to offer an update on diagnosis classifications, natural history, and conservative management in CM.</p><p><strong>Background: </strong>CM type 1 involves cerebellar tonsil herniation leading to neurological symptoms. There is controversy regarding its pathophysiology and optimal management, especially for asymptomatic cases. Previous research has focused on surgical outcomes with limited consensus on conservative strategies. Standardized guidelines are needed to enhance clinical decision-making.</p><p><strong>Materials and methods: </strong>The screening process involved reviewing abstracts, assessing full-text articles, and reviewing references. Eligibility criteria ensured the selection of relevant studies. Data extraction involved recording various variables. Results were discussed and voted on in 2 consensus meetings of the World Federation of Neurosurgical Societies Spine Committee, reaching a consensus using the Delphi method.</p><p><strong>Results: </strong>A total of 164 abstracts were screened. Ninety-nine articles met the inclusion criteria and were included in the study. Headache, brainstem, and/or cerebellar/brainstem symptoms/signs were confirmed as the main typical neurological hallmarks of CM. Still, an accurate clinical assessment appeared to be the most reliable evaluation model available. Considering classification, the most common form in adults is type 1, whereas type 2 is associated with myelomeningocele and hydrocephalus from childhood. Magnetic resonance imaging is the gold standard to show the extent of tonsillar herniation, overcrowded posterior fossa, or the absence of cisterna magna. Focusing on natural history, for asymptomatic or mildly symptomatic radiologically positive patients conservative management is appropriate. Somatosensory, motor, brainstem auditory evoked potentials and polysomnography could be helpful to guide eventual surgical indication.</p><p><strong>Conclusion: </strong>Further, higher-quality studies are recommended to establish more substantial evidence and recommendations.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"767-778"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143383337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnosis, Classifications, and Treatment of Os Odontoideum: WFNS Spine Committee Recommendations.","authors":"Oscar L Alves, June Ho Lee, Djamel Kitumba, Agnaldo Lucas, Saleh Baeesa, Said Ben Ali, Francisco Sampaio, Gustavo Uriza, Ricardo Gepp, Mehmet Zileli, Ricardo Botelho, Jörg Klekamp, Atul Goel","doi":"10.1097/BRS.0000000000005277","DOIUrl":"10.1097/BRS.0000000000005277","url":null,"abstract":"<p><strong>Study design: </strong>A systematic literature review and consensus using the Delphi method.</p><p><strong>Objective: </strong>The aim was to formulate consensus recommendations regarding the natural history, diagnosis, classification, and optimal treatment of os odontoideum with global applicability.</p><p><strong>Summary of background: </strong>Os odontoideum (OO) is a rare anomaly of the cranio-vertebral junction (CVJ). Due to the paucity of literature, there is still considerable debate about the clinical management of OO.</p><p><strong>Materials and methods: </strong>Using PubMed, the authors reviewed the literature on OO published from 2011 to 2022. Using the Delphi method, a panel of expert spine surgeons and members of the WFNS Spine Committee analyzed the strength of the published literature and elaborated and voted on statements concerning diagnosis and management.</p><p><strong>Result: </strong>The diagnosis may be established incidentally. Symptoms may manifest as neck discomfort or encompass occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Diagnosis is usually made with plain radiographs and CT scans. Dynamic x-rays identify C1-C2 instability, whereas MRI assesses spinal cord integrity and compression. Asymptomatic cases lacking radiologic instability are generally handled through regular observation and serial imaging until predictors of neurological deterioration necessitate surgical intervention. In the event of atlantoaxial instability or neurological dysfunction, surgical intervention with instrumentation and fusion is required to maintain stability. In irreducible cases, C1-2 joint manipulation and distraction permits realignment and deformity correction avoiding decompression, either from anterior or posterior.</p><p><strong>Conclusions: </strong>The management guidelines for asymptomatic OO are still a gray zone as our understanding of the natural history is still vague. Therefore, we need more large-center studies to investigate this condition further. Whenever symptomatic, unstable, or asymptomatic presenting with risk factors, OO is better managed with atlantoaxial fusion, avoiding occipital inclusion in the construct. In irreducible OO, C1-C2 joint manipulation and distraction are preferred to decompression.</p>","PeriodicalId":22193,"journal":{"name":"Spine","volume":" ","pages":"743-750"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Jiri Dvorak: 2025 ISSLS Wiltse Lifetime Achievement Award.","authors":"Dino Samartzis, Robert Gunzburg","doi":"10.1097/BRS.0000000000005339","DOIUrl":"https://doi.org/10.1097/BRS.0000000000005339","url":null,"abstract":"","PeriodicalId":22193,"journal":{"name":"Spine","volume":"50 11","pages":"733-736"},"PeriodicalIF":2.6,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}