Release notes of Occipitocervical trauma

The content was revised by Cumhur Öner (Netherlands) with Luiz Vialle (Brazil) as executive editor.

The main difference to the first edition is the implementation of the new upper cervical injuries classification, outlined in a dedicated page.

Type A: Isolated bony injury (condyle):

• Nonoperative treatment (collars)

Type B: Nondisplaced ligamentous injury (craniocervical):

• Halo vest
• Occipitocervical fusion

Type C: Any injury with displacement:

• Occipitocervical fusion

Type A: Isolated bony injury:

• Nonoperative treatment (collars)
• Halo vest

Type B: Nondisplaced ligamentous injury:

• Halo vest
• Posterior C1–C2 fusion
• C1 lateral mass osteosynthesis

Type C: Translation injury of the C1–C2 joint:

• Halo vest
• Posterior C1–C2 fusion
• Occipitocervical fusion

Type A: Isolated bony injury of C2:

• Nonoperative treatment (collars)
• Halo vest
• Anterior odontoid screw
• Posterior C1–C2 fusion

Type B: Nondisplaced ligamentous injury:

• Nonoperative treatment (collars)
• Halo vest
• Posterior C2–C3 fusion
• Direct osteosynthesis of the isthmus
• Anterior C2–C3 fusion

Type C: Translation injury:

• Anterior C2–C3 fusion
• Posterior C2–C3 fusion
• Posterior C1–C3 fusion

Approaches:

• Anterior access to C1–T2
• Posterior access to C1–T2

Patient preparations:

• Prone position
• Supine position

Further reading:

• AO Spine upper cervical injuries classification system
• Clinical evaluation
• Neurological evaluation
• Radiological evaluation (XR, CT, MRI)

Basic techniques:

• Anterior C1–C2 transarticular screw insertion
• C1 lateral mass screw insertion
• C2 laminar screw insertion
• C2 pars screw insertion
• C2 pedicle screw insertion
• Lateral mass screw insertion (Magerl technique)
• Occipital condyle screw insertion
• Pedicle screw insertion in the cervical spine
• Transarticular screw insertion

The content was created by Ronald Lehman (USA), Daniel Riew (USA), and Klaus Schnake (Germany), with Luiz Vialle (Brazil) as executive editor.

The occipitocervical trauma material, first edition, included a detailed description of the following injury types and their management.

Anderson D’Alonzo Type I:

• Hard collar

Anderson D’Alonzo Type II:

• Anterior C1–C2 transarticular screws
• Halo vest
• Hard collar
• Odontoid screw fixation
• Posterior C1–C2 fixation

Anderson D’Alonzo Type III:

• Halo vest
• Hard collar
• Odontoid screw fixation
• Posterior C1–C2 fixation

Atlanto-occipital dissociation:

• Occipitocervical fusion screw fixation
• Temporary halo and traction

Atlas Type I:

• Soft collar

Atlas Type II:

• Soft collar

Atlas Type IIIA:

• Hard collar

Atlas Type IIIB:

• C1 lateral masses osteosynthesis
• Halo vest
• Posterior C1–C2 fusion

Atlas Type IV:

• Halo vest
• Hard collar
• Occipitocervical fusion

Atlas Type V:

• Collar

C0 fractures:

• Hard collar
• Occipitocervical fusion screw fixation

C1–C2 dislocation:

• Anterior C1–C2 fusion
• Posterior C1–C2 fusion

C1–C2 rotatory subluxation:

• Anterior C1–C2 fusion
• Halo vest
• Hard collar
• Posterior C1–C2 fusion

C2 body fracture:

• Halo vest
• Hard collar
• Posterior fixation

Traumatic spondylolisthesis Effendi Type I:

• Hard collar

Traumatic spondylolisthesis Effendi Type II:

• Anterior fixation
• Halo vest
• Posterior fixation

Traumatic spondylolisthesis Effendi Type III:

• Halo vest
• Posterior fixation

Traumatic spondylolisthesis Levine IIA:

• Anterior fixation
• Direct osteosynthesis of the isthmus
• Halo vest
• Posterior fixation

Approaches:

• Anterior access to C1–T2
• Posterior access to C1–C2

Further reading:

• Patient examination: clinical evaluation
• Patient examination: neurological evaluation
• Patient examination: radiological evaluation (XR, CT, MRI)