title: Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique.
abstract: METHODS
  Retrospective descriptive study of an innovative surgical technique.
  
  
  OBJECTIVE
  To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases.
  
  
  BACKGROUND
  C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications.
  
  
  METHODS
  Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain.
  
  
  RESULTS
  The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery-mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%).
  
  
  CONCLUSIONS
  Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.
authors.affiliation: Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Ajit Kumar
authors.initials: AK
authors.lastname: Sinha
authors.affiliation: Department of Neurosurgery, Sir Ganga Ram Hospital, New Delhi, India.
authors.forename: Sumit
authors.initials: S
authors.lastname: Goyal
keywords: Atlanto-axial; C1-C2 posterior fusion; CV junction; bone graft; myoarchitectonic