Background: Cervical spine injuries are common as a result of a growing number of high energy accidents. The subaxial Injury Classification System and Severity Score (SLICS) suggest that a unilateral or bilateral facet dislocation must be managed surgically, even in the absence of SCI (Level of Evidence III). The surgical approaches could be anterior, posterior or combined anterior and posterior approaches. Methods: 20 patients, 12 males and 8 females, with age ranged from 20 to 45 years with lower cervical spine locked facet treated operatively by anterior or posterior spinal instrumentation after trial of closed reduction by skull traction. Results: In this series, satisfactory closed reduction was achieved in 15 patients with percentage 75% and fixed anteriorly, but 5 patients with percentage 25% needed posterior approach for reduction. Regarding ASIA score all of the patients improved at least one level after surgery except 2 cases with preoperative score A: they didn't improve. Mean preoperative pain score VAS was 7.7 (range from 5 to 9) and postoperative mean of VAS was 0.75 with range from 0 to 3 until final follow up. Conclusion: Anterior approach with discectomy and fusion is necessary; however, if the closed reduction failed, posterior open reduction is indicated with lateral mass fixation, combined approaches can be indicated in specific cases such as increase of the kyphotic angle post anterior approach or when an osteotomy may be required to restore cervical alignment and neural decompression.

Background: Os odontoideum is a separate odontoid process from the body of the axis. It is a rare anomaly of the craniovertebral junction with evidence of both congenital and acquired causes but the aetiology still debated in the literature. It can lead to instability of the atlantoaxial joint and places the spinal cord at significant risk. Methods: Eight cases of os odontoideum were symptomatic at time of presentation, submitted for general and neurological examination, and investigated with different radiological modalities and managed with surgical fixation and stabilization. These patients followed for one year postoperatively. Results: The study includes six male patients and two female patients with median age 18.7 years. All patients presented with myelopathy and showed clinical evidence of atlantoaxial instability. They submitted for complete radiological investigations (plain x ray, CT scan and MRI) craniocervical junction. They underwent cervical surgical stabilization, two cases by atlantoaxial arthrodesis with wiring, two atlantoaxial fixation by lateral mass screw one of them with transoral odontoiectomy, two atlantoaxial fixations by a Rosen's Hooks, and two cases craniocervical fixation by Tie frame. Death postoperatively recorded in two patients. Follow-up one year revealed resolution of symptoms in two patients and four patients remained stationary but without deterioration. Conclusion: Os odontoideum is a rare but sometimes lethal abnormality that requires radiological and clinical judgement to ensure the best choice of management and optimum patient's care.

Background: Lumbar burst fractures are common spinal injuries that cause severe instability with kyphotic deformities and neurological complications requiring surgical decompression and reconstruction with spinal instrumentation for unstable burst fracture, but there is controversy about the optimal surgical approach anterior, posterior or combined approach. Objectives: To assess the efficacy & safety of anterolateral approach in decompression and reconstruction with spinal instrumentation for lumbar burst fractures. Subjects & Methods: A retrospective study including 16 patients, 10 males and 6 females with lumbar burst fractures and anterior compression treated operatively by anterolateral approach for corpectomy and single level fusion by using expandable cage or mesh cage loaded with bone graft and plat with screws. The clinical and radiological follow up after discharge from the hospital ranged from 12 to 24 months. Results: All patients improved regarding the Frankel score more than one grade after surgery, except 2 cases of grade A didn't improve. Mean preoperative visual analogue scale was 7.4 improving to 0.9 postoperatively. The mean Local kyphosis improved from 8.8˚ before surgery to −1˚ after surgery. Conclusions: Anterolateral approach is feasible, effective, and safe approach for unstable lumbar burst fractures. Angular deformity is successfully corrected when the anterior approach is used.

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