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During a C1-C2 posterior spinal fusion, while performing the dissection of posterior arch of C1 and pedicle of C2, the surgeon encounters rapid pulsatile arterial bleeding. The artery is tamponaded off,vascular surgery is consulted and an intra-operative angiogram is performed. Given adequate collateral flow, the injured artery is embolized. Post-operatively the patient's neurologic function is normal. Injury to this arterial structure could have best been avoided by minimizing dissection in which of the following areas?
Dorsolaterally along the C1-C2 facet, medial to the foramen transversarium
Ventral along the medial border of the the pars of C2
Cephalad to the posterior arch of C1 when > 1.5cm lateral to the midline
Caudal to the posterior arch of C1 when < 1.0cm lateral to the midline
Cephalad to the posterior arch of C1 when < 1.0cm lateral to the midline
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During the posterior exposure of the atlas arch in the cervical spine, excessive retraction of >2 cm past midline would cause injury to an anatomical structure. Which of the following statements is true about this structure?
Injury to this structure causes postoperative hoarseness
The structure is a branch of the vagus nerve
Injury to this structure causes weakness in forearm supination
The structure typically originates from the subclavian artery and travels cephalad through the transverse foramen
The structure is a terminal branch of the common carotid artery
A 75-year old female presents to the ER after a motor vehicle collision where she was rear-ended. Her imaging studies are shown in Figures A through C. She undergoes posterior stabilization and instrumented fusion (PSIF) without complications. During surgery, C1 lateral mass screws are placed with a starting point directly beneath the medial edge of the posterior arch at the point where it joins the lateral mass. The screws are directed 10 degrees medial and 22 degrees cephalad in order to be:
Inferior and medial to the vertebral artery
Inferior and lateral to the vertebral artery
Superior and medial to the vertebral artery
Superior and lateral to the vertebral artery
Superior and aligned in the coronal plane