[Fractures of the upper cervical spine--indications for treatment]

Over 2 years, 16 patients with a total of 23 lesions of the craniovertebral junction and the upper cervical spine were treated. Clinically important aspects of diagnosis and classification are outlined. The conditions treated included fractures of the occipital condyle and atlas, dens-axis, and hanged-man fractures. Standard operative treatment, which has to be modified in cases of combined injuries, is presented. Surgery is frequently indicated, especially in elderly and polytraumatized patients. In addition, 2 cases of atlanto-occipital dislocation are described: 1 of these patients survived for 5 days after early atlanto-occipital fusion.