AOSpine Needs Assessment

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Pipsa Ylanko, AOSpine Global Education Manager

General Editor: Luiz Vialle

Authors: Ronald Lehman, Daniel Riew, Klaus Schnake

Occipitocervical trauma

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Glossary

C0 fractures

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Stable fracture. Basic surgical experience, no specialized skills Simple surgical and imaging resources
Occipitocervical fusion (screw fixation) Unstable fractures. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Atlanto occipital dissociation

Please select a treatment option:
Treatment Main indication Skill Equipment
Temporary halo and traction Acute treatment pending operative treatment. Some specialized surgical experience Simple surgical and imaging resources
Occipitocervical fusion (screw fixation) All atlanto occipital dissociations. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

ATLAS Type I

Please select a treatment option:
Treatment Main indication Skill Equipment
Soft collar All type I fractures. Basic surgical experience, no specialized skills Basic equipment only

ATLAS Type II

Please select a treatment option:
Treatment Main indication Skill Equipment
Soft collar All type II fractures. Basic surgical experience, no specialized skills Basic equipment only

ATLAS Type IIIa

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar All type IIIa fractures. Basic surgical experience, no specialized skills Basic equipment only

ATLAS Type IIIb

Please select a treatment option:
Treatment Main indication Skill Equipment
Halo vest Type IIIb fractures with ligament avulsion. Some specialized surgical experience Simple surgical and imaging resources
C1 lateral masses osteosynthesis Type IIIb fracture with bony avulsion of transverse ligament. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior C1-C2 fusion ATLAS IIIb fracture with pure rupture of transverse ligament. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

ATLAS Type IV

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Minimal displacement. Basic surgical experience, no specialized skills Basic equipment only
Halo vest Severe displacement. Some specialized surgical experience Simple surgical and imaging resources
Occipitocervical fusion Secondary displacement after halo vest. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

ATLAS Type V

Please select a treatment option:
Treatment Main indication Skill Equipment
Collar All type V fractures. Basic surgical experience, no specialized skills Basic equipment only

C1-C2 Rotatory subluxation

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Reducible acute C1-C2 rotatory subluxation in children. Basic surgical experience, no specialized skills Basic equipment only
Halo vest Reducible acute C1-C2 rotatory subluxation in older children. Basic surgical experience, no specialized skills Basic equipment only
Anterior C1-C2 fusion Reducible acute C1-C2 rotatory subluxation. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior C1-C2 fusion Acute case with severe dislocations. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

C1-C2 Dislocation

Please select a treatment option:
Treatment Main indication Skill Equipment
Anterior C1-C2 fusion C1-C2 dislocation. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior C1-C2 fusion C1-C2 dislocation. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anderson d'Alonzo Type I

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Treatment of choice. Basic surgical experience, no specialized skills Basic equipment only

Anderson d'Alonzo Type II

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Non- or minimally displaced fracture. Basic surgical experience, no specialized skills Basic equipment only
Halo vest Non- or minimally displaced fracture. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Odontoid screw fixation Reducible type II odontoid fracture with transverse fracture of the neck of the odontoid process. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterior C1-C2 trans articular screws Type II dense fractures with associated C1-C2 instability or prone positioning contraindicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior C1-C2 fixation Odontoid type II fracture. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Anderson d'Alonzo Type III

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Non- or minimally displaced fracture. Basic surgical experience, no specialized skills Basic equipment only
Halo vest Displaced injuries. Some specialized surgical experience Simple surgical and imaging resources
Odontoid screw fixation Certain type III odontoid fractures with sufficient bone stock in the C2 body to secure a stable construct. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior C1-C2 fixation Unstable or dislocated fractures combined with C2 injuries. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

C2 Body fracture

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Non- or minimally displaced fracture. Basic surgical experience, no specialized skills Basic equipment only
Halo vest Displaced injuries. Some specialized surgical experience Simple surgical and imaging resources
Posterior fixation Unstable or dislocated fractures. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Effendi Type I

Please select a treatment option:
Treatment Main indication Skill Equipment
Hard collar Standard treatment for all Effendi type I fractures. Basic surgical experience, no specialized skills Basic equipment only

Effendi Type II

Please select a treatment option:
Treatment Main indication Skill Equipment
Halo vest Reducible injuries without gross dislocation. Some specialized surgical experience Simple surgical and imaging resources
Anterior fixation Treatment of choice if closed reduction is possible. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior fixation Significantly displaced Injuries which cannot be reduced anatomically. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Levine IIa

Please select a treatment option:
Treatment Main indication Skill Equipment
Halo vest Reducible injuries without gross dislocation. Some specialized surgical experience Simple surgical and imaging resources
Direct osteosynthesis of the isthmus Reducible injury without significant displacement. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Posterior fixation Significantly displaced injuries which cannot be reduced anatomically. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
Anterior fixation In cases where the posterior fixation is contraindicated. Highly experienced and skilled surgeon Full specialized surgical and imaging resources

Effendi Type III

Please select a treatment option:
Treatment Main indication Skill Equipment
Halo vest Reducible injuries without gross dislocation. Some specialized surgical experience Simple surgical and imaging resources
Posterior fixation Surgical treatment of choice, allowing direct reduction of the facet dislocation. Highly experienced and skilled surgeon Full specialized surgical and imaging resources
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2016.12.01