gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Management of occipitocervical trauma in adult patients

Meeting Abstract

  • Ahmet Dagtekin - Department of Neurological Surgery, University of Mersin, Turkey
  • Anil Ozgur - Department of Radiology, University of Mersin, Turkey
  • Mehmet Ali Karatas - Department of Neurological Surgery, University of Mersin, Turkey
  • Emel Avci - Department of Neurological Surgery, University of Mersin, Turkey
  • Hamza Karabag - Department of Neurological Surgery, University of Harran, Turkey
  • Mustafa K. Baskaya - Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, United States

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocP 119

doi: 10.3205/14dgnc515, urn:nbn:de:0183-14dgnc5154

Published: May 13, 2014

© 2014 Dagtekin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: The unique ligamentous and bone anatomy of the occipitocervical junction (OCJ) and the typical mechanisms of trauma yield a predictable variety of injury patterns. It is advantageous to classify injury of the OCJ as isolated ligamentous injuries, isolated bone fractures, or mixed ligamentous and bony injuries. This study was conducted to emphasize the importance of anatomy, diagnosis and appropriate treatment of trauma OCJ.

Method: Fortyfive patients (31 male, 14 female, mean age 44 years) were admitted during a 5-year-period for injuries of the upper cervical spine. Patients were followed for a mean time of 18 months. Two occipital condyle fractures, 13 isolated C1 fractures, 5 combined C1/C2 fractures, 4 rotatory C1/C2 dislocations and 21 C2 fractures (15 odontoid, 3 hangman’s, 3 miscellaneous fractures) were diagnosed. Stability was evaluated using flexion-extension radiography. In addition to clinical cases five cadavers were used to study the microsurgical anatomy and to demonstrate OCJ in a step-wise manner.

Results: Isolated fractures of atlas (nondisplaced or minimally displaced) heal satisfactorily with an orthosis. Odontoid Type II fractures (less than 6 mm dens displacement) primarily treated with halothoracic vest. Unstable odontoid type II fractures primarily treated with C1-C2 wire/graft (two patients). Unstable subtype of hangman’s fracture primarily treated with anterior cervical plating. Operative mortality and neurological morbidity were found in 0%.

Conclusions: Ligamentous structures must be evaluated on MRI carefully for treatment modality. Isolated ligamentous instabilities, odontoid Type II fractures with dislocation more than 6 mm and unstable subtype of hangman’s fractures require surgical treatment. When fractures extend into the foramen transversarium or a subluxation is found on radiological investigation, vertebral artery injuries must be kept in mind.