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Vertebral Artery Pseudoaneurysm Resulting in Embolic Stroke as a Complication of Posterior C1 Lateral Mass Screw FixationA Case Report
Danielle Y. Ponzio, MD1; Alexander R. Vaccaro, MD1; James S. Harrop, MD1; Robert J. Ponzio, DO1; Christopher K. Kepler, MD1; Dennis Meredith, MD1
1 Department of Orthopaedic Surgery, Rothman Institute (D.Y.P., A.R.V., R.J.P., C.K.K., D.M.,), Department of Neurosurgery (J.S.H.), Thomas Jefferson University, 1015 Walnut Street, Room 801, Philadelphia, PA 19107. E-mail address for D.Y. Ponzio: danielle.ponzio@gmail.com
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Investigation performed at the Rothman Institute, Philadelphia, Pennsylvania

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
JBJS Case Connector, 2013 Sep 25;3(3):e93 1-5. doi: 10.2106/JBJS.CC.M.00109
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Current literature supports posterior screw instrumentation of the C1 lateral mass as a reliable procedure for treating many occipitocervical and atlantoaxial pathologies with a low incidence of vertebral artery and neurologic injury and a high accuracy rate for screw placement1-6. The rate of vertebral artery injury from Cl lateral mass screw fixation is unknown1,2. Bransford et al. reported no neurologic or vascular complications in a large series, despite cases of suboptimal screw placement2. However, the variable and unique C1 anatomy can make precise instrumentation challenging with the rare potential for vascular and neurologic injury.
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