Upper Cervical Fractures

The upper cervical spine including the occiput, atlas, and axis has unique anatomic and functional roles. In addition to supporting and connecting the skull to the subaxial spine, the upper cervical spine is also responsible for much of total range of motion of the cervical spine. Traumatic injury to the upper cervical spine can have severe complications and therefore should always be assessed in patients suspicious for head and neck trauma. CT and MRI scans should be utilized in patients with head and neck trauma to evaluate the bony and ligamentous structures of the upper cervical spine. Due to the unique bony and ligamentous structures and functionally unique articulations of the upper cervical spine, multiple different classification systems have been previously proposed to identify and guide treatment of these injuries. These prior classification systems were limited in that none of them encompassed the entire upper cervical spine and many of them lacked guidance on treatment options for specific injuries. Recently, the AO upper cervical injury classification system was proposed which includes the entire upper cervical spine and seeks to guide treatment based on the classification of the injury.