Instrumentation of the occipital-atlantal-axial (c0-c1-c2) complex

Few areas of spinal surgery present a greater challenge than management of occipitocervical abnormalities. This is due to the simultaneous presence of two commanding, yet conflicting treatment principles. First, decompression and protection of the spinal cord at this level is synonymous with the presevation of life itself. Second, however, the degree of cervical movements at this junction is unprecedented in the spine, requiring the preservation movement yet stabilization of discrete motion segemnts. The interrelation of these two critical functions is realized in the complex arrangement of the C0- C1-C2 anatomic configuration. The occipitocervical junction is responsible for 50% of the 90 degrees of head rotation. In addition, 10-15 degrees of flexion and extension are added to the subaxial cervical spine by C0-C1-C2.This duality of function is the primary reasin for the complexity of the facet joints in this location. No lateral bending occurs at this level.