General Editor: Luiz Vialle

Authors: Ronald Lehman, Daniel Riew, Klaus Schnake

Occipitocervical trauma - Traumatic spondylolisthesis, EffIII Posterior fixation

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1 Introduction top

Posterior instrumentation is either combined with open reduction, or is performed after closed reduction has been successfully achieved.

2 Appraoch and positioning top


This procedure is performed through a posterior approach with the patient placed in the prone position.

3 Open reduction top


In type III fractures, close reduction is typically not possible and is performed open from posterior.


A bilateral facet dislocation can be unlocked with gentle manual distraction applied across clamps placed on the spinous processes above and below the injury.

In specific situations, this can be facilitated by prying the facets apart directly with an elevator or partial resection of the superior facet as described above for unilateral facet dislocations

Once reduction has been achieved, posterior instrumentation should be applied. 


Partial facetectomy in the form of resection of the superior-most projection of the superior facet of the level below the dislocation may facilitate facet reduction.

4 C2-C3 posterior fusion top


C2 Screws

Polyaxial pedicle screws are inserted into C2 following the standard technique.


C3 Screws

For fixation of C3, one of the following techniques can be applied:


Rod insertion

The rod is placed and screws are closed with slight compression to enhance the stability of the construct. 

v1.0 2016.12.01