Craniocervical Traumatic Injuries: Evaluation and Surgical Decision Making

We present a literature review of current approaches to craniocervical traumatic injuries. In an attempt to categorize the injuries that involve the upper cervical spine, we divide the injuries into two groups: (1) injuries affecting mainly bone structures and (2) predominantly ligamentous injury. This division is based on the principle that bone injuries have the potential to heal with conservative treatment whereas ligamentous injury would not heal properly, leading to an unstable spine. An accurate diagnosis and treatment are necessary to improve patient's outcome and avoid complications. As a general rule, ligamentous injuries are unstable lesions, requiring surgical treatment. Bony injuries can be conservatively treated, with surgery reserved for more unstable patterns (unstable C1 ring, displaced odontoid or C2 pars fractures).