General Editor: Luiz Vialle

Authors: Ronald Lehman, Daniel Riew, Klaus Schnake

Occipitocervical trauma - Traumatic spondylolisthesis, Levine IIa Posterior fixation

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Authors: Ronald Lehman, Daniel Riew, Klaus Schnake

1 Introduction top

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

2 Reduction top

Reduction may be performed by gentle traction, especially in acute cases. If not achieved or in more delayed cases, surgical reduction is indicated.

This involves soft tissue release (ligaments, capsules and scar tissues found in delayed presentation) followed by gentle manipulation.

The final reduction must be confirmed using a C-arm.

3 Appraoch and positioning top


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

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