[High cervical spine injuries: classification, therapeutic indications, and surgical approaches: 286 consecutive cases].
Around 60% of all cervical fractures occur in the high cervical segment (C0-C1-C2); 4-15% occurs in C1, and between 15-25% in the axis. Nowadays, with high resolution imaging, we can see both anatomic and functional aspects of the fractures, as well as understand the mechanisms of injury. This can also allow us to study the evolution of the soft tissue lesions and fractures. The classification of traumatic injuries in C0-C1-C2 is basic in order to understand the mechanism of injury and natural history of these lesions. This also allow us to choose the correct or most adequate form of treatment. In the cases where surgery is indicated we must: a) release of the cord or nerves, using standard techniques such as laminectomy, discectomy or corpectomy; b) align vertebral segments using traction, halo vest or surgery; c) estabilize the vertebral segments, using anterior, posterior or 360 degrees surgical approaches; d) stop the natural history of disease and e) allow maximal functional recovery. Although there are good classifications that typify the fractures in the C0-C1-C2 segments, there are not clear or standard treatments for them. This paper shows the personal experience of the author in the management of this type of fractures. The 286 patients with lesions in the high cervical segment C0-C1-C2 have been treated according to the classifications and recommendations already established in the literature. Selection of this cases and appropiate surgical approach is still a challenge for surgeons who deal with this problems.