Surgical methods for fractures of upper cervical spine

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A. Atlas fractures (C1)

    Jefferson fractures with ligamentous avulsions, and resulting lateral dislocation of C1 in relation to
    C2 require surgery urgently. The surgical options available are:

    1. Harms transoral repositioning and osteosynthesis of C1

    2. C0/C2 fusion

B. Atlantooccipital dislocation (C0/C1)

    1. Transoral C0/C1 fusion

    2. Dorsal C0/C1 fusion

    3. C0/C1/C2 fusion as needed

C. Axis fracture C2)

    C1. Type I fractures with ligamenta alaria avulsions

    1. fusion operation

    C2. Type II fractures

    1. Classic surgical treatment with ventral screws using the Böhler method

    2. Osteosynthesis of C1/C2 with or without fusion

    C3. Type III fractures

    1. Surgical repositioning with C1/C2 instrumentation using the Harms technique.

D. Atlantoaxial dislocation (C1/C2)

    1. dorsal repositioning and instrumentation C1/C2, in most cases with a definitive fusion

E. Traumatic spondylolysis (C2), "hangman´s fracture"

    1. direct C2 screw fixation using the Judet method