When is inclusion of C2 vertebra in the fixation construct necessary in cases with multi-level spinal degeneration?

In addition to being held together by the intervertebral discs, adjacent vertebrae also articulate with each other at synovial joints formed between the superior and inferior articular processes called zygapophysial joints (facet joints). These are plane joints that provide for only limited motions between the vertebrae. The orientation of the articular processes at these joints varies in different regions of the vertebral column and serves to determine the types of motions available in each...

The vertebral column or spine is a flexible column that supports the head, neck, and body and  allows for their movements. It also protects the spinal cord.
Regions of the Vertebral Column
In an adult, the spine is subdivided into five regions: the cervical, the thoracic, the lumbar, the sacral, and the coccygeal region. The spine initially develops as a series of 33 vertebrae; after 20 years of age, the nine bones in the sacral region, five sacral, and four coccygeal bones fuse to form...

A typical vertebra, with the exception of the sacrum and coccyx, consists of a body, a vertebral arch, and seven different projections termed processes. The anterior portion of the vertebrae, the body, supports about half the body’s weight. The vertebral bodies progressively increase in size and thickness from the cervical region to the lumbar region of the vertebral column. The intervertebral discs present between the bodies of adjacent vertebrae firmly unites them, forming a continuous...