Narrative review of upper cervical spine injuries (occiput through C2) covering anatomy, radiographic evaluation, injury classification, and management of occipitocervical dissociation, atlas fractures, transverse ligament ruptures, odontoid fractures, and hangman's fractures.
When evaluating upper cervical trauma, apply the rule of 12 on lateral XR (basion-axial and basion-dental intervals both <12 mm normal) and measure total C1 lateral mass overhang on open-mouth view — overhang >6.9 mm means the transverse ligament is gone and conservative management will fail.
The core decision rule: ligamentous injuries need surgery, bony injuries usually don't — but type II odontoid fractures and type IIA hangman's fractures each have management traps (nonunion risk and traction contraindication, respectively) that demand individualized treatment.
Narrative review of upper cervical spine injuries (occiput through C2) covering anatomy, radiographic evaluation, injury classification, and management of occipitocervical dissociation, atlas fractures, transverse ligament ruptures, odontoid fractures, and hangman's fractures.
When evaluating upper cervical trauma, apply the rule of 12 on lateral XR (basion-axial and basion-dental intervals both <12 mm normal) and measure total C1 lateral mass overhang on open-mouth view — overhang >6.9 mm means the transverse ligament is gone and conservative management will fail.
The core decision rule: ligamentous injuries need surgery, bony injuries usually don't — but type II odontoid fractures and type IIA hangman's fractures each have management traps (nonunion risk and traction contraindication, respectively) that demand individualized treatment.