Overview of Surgical Techniques and Implants for the Anterior Upper Cervical Spine

Abstract

The upper cervical spine represents a unique biomechanical and anatomic region that requires specialized surgical techniques and implants. Most commonly, the upper cervical spine is affected by trauma (odontoid fractures and nonunions), occipital-cervical dislocations, or degenerative processes, particularly rheumatoid arthritis, which results in atlantoaxial instability. Trauma indications include Jefferson fractures with instability and disruption of the transverse ligament, odontoid fractures that are mobile in flexion and extension, and C1–2 dislocations. In rheumatoid degenerative instability of the C1–2 joints, the indications are also decompression of the spinal cord and then subsequent stabilization. The four most common surgical techniques for the region are anterior odontoid screw fixation, transoral resection of the odontoid process, posterior C1–2 fixation, and anterior transarticular screw fixation.