Posterior surgical approaches to upper cervical traumas

Objective: Upper cervical traumas are severe injuries that often result in high morbidity and mortality rates. The occipitocervical junction requires careful consideration due to its unique anatomical and biomechanical characteristics. This study aims to analyze the preoperative and postoperative outcomes of clinical data obtained through posterior surgical approaches for upper cervical traumas, evaluate the effectiveness of surgical stabilization techniques, and contribute to surgical practices by comparing the findings with existing literature. Materials and methods: This retrospective study was conducted at the Department of Neurosurgery, Faculty of Medicine, Ordu University. A total of 31 patients who presented with upper cervical trauma between February 2020 and May 2022 and met the eligibility criteria were included in the study. Radiological assessments in the preoperative and postoperative periods analyzed upper cervical alignment parameters (C0-C2 lordosis, C2-C7 lordosis, clivoaxial angle, C2 slope, cranial slope, and SVA), neurological status, surgical complications, and recovery processes. Surgical techniques included posterior approaches with Harm's technique for C1-2 levels, C2 transpedicular fixation and C3 lateral mass fusion for C2-3 stabilization, and supplementary fusion methods for patients with additional pathologies. Data were analyzed statistically using SPSS software with a significance level of p<0.05. Results: The causes of trauma were identified as falls from height (45.2%), falls from stairs (19.4%), falls from standing height (16.1%), motor vehicle accidents (12.9%), and axial head trauma (6.5%). Fracture distribution was as follows: 54.83% were C2 Type 2 odontoid fractures, 9.64% were C1 Jefferson fractures, and 35.53% were other fracture types. The minimum follow-up period was 6-24 months, during which all patients achieved radiological stabilization, and no fusion defects were observed. Significant changes were noted in cervical parameters, particularly SVA (p=0.03) and cranial slope (p=0.026). Conclusion: Posterior surgical approaches provide an effective and safe treatment option for upper cervical traumas. Proper application of stabilization techniques is crucial for neurological recovery and prevention of complications. This study aims to contribute to the existing literature on the surgical management of upper cervical traumas and share clinical experiences to enhance surgical practices. Further long-term and large-scale studies are necessary to support these findings. Keywords: upper cervical trauma, odontoid fracture, Hangman's fracture, Jefferson fracture