Upper cervical injuries - A rational approach to guide surgical management

Andrei F. Joaquim*, Enrico Ghizoni, Helder Tedeschi, Brandon Lawrence, Darrel S. Brodke, Alexander R. Vaccaro, Alpesh A. Patel

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

27 Scopus citations


Context: The complex anatomy and the importance of ligaments in providing stability at the upper cervical spine region (O-C1-C2) require the use of many imaging modalities to evaluate upper cervical injuries (UCI). While separate classifications have been developed for distinct injuries, a more practical treatment algorithm can be derived from the injury pattern in UCI. Objective: To propose a practical treatment algorithm to guide treatment based on injuries characteristic of UCI. Methods: A literature review was performed on the Pubmed database using the following keywords: (1) "occipital condyle injury"; (2) "craniocervical dislocation or atlanto-occipital dislocation or craniocervical dislocation"; (3) "atlas fractures"; and (4) "axis fractures". Just articles containing the diagnosis, classification, and treatment of specific UCI were included. The data obtained were analyzed by the authors, dividing the UCI into two groups: Group 1 - patients with clear ligamentous injury and Group 2 - patients with fractures without ligament disruption. Results: Injuries with ligamentous disruption, suggesting surgical treatment, include: atlanto-occipital dislocation, mid-substance transverse ligament injury, and C1-2 and C2-3 ligamentous injuries. In contrast, condyle, atlas, and axis fractures without significant displacement/misalignment can be initially treated using external orthoses. Odontoid fractures with risk factors for non-union are an exception in Group 2 once they are better treated surgically. Patients with neurological deficits may have more unstable injuries. Conclusions: Ascertaining the status of relevant ligamentous structures, fracture patterns and alignment are important in determining surgical compared with non-surgical treatment for patients with UCI.

Original languageEnglish (US)
Pages (from-to)139-151
Number of pages13
JournalJournal of Spinal Cord Medicine
Issue number2
StatePublished - Mar 2014


  • Classification
  • Injury
  • Management
  • Traumatic
  • Treatment
  • Upper cervical spine

ASJC Scopus subject areas

  • Clinical Neurology


Dive into the research topics of 'Upper cervical injuries - A rational approach to guide surgical management'. Together they form a unique fingerprint.

Cite this