Approach to upper cervical trauma

Upper cervical spine injuries are relatively common and are often the result of blunt trauma. These injuries can be neurologically devastating and can have a high mortality. Management of these injuries requires an in-depth understanding of the complex anatomy of this region, delineation of the injury morphology, and classification after appropriate imaging. The treatment, surgical or conservative, is based on the neurological injury and structural instability.Bony injuries of the upper cervical spine, such as the occipital condylar fractures, fractures of the atlas, majority of odontoid fractures, and traumatic spondylolisthesis of the axis, respond well to nonsurgical management by external immobilization. In contrast, ligamentous injuries of the atlanto-occipital joints or the transverse atlantal ligament (TAL) have a poorer prognosis for healing and often require surgical intervention.