SynthesisInternational orthopaedics2020
Injuries of the upper cervical spine-how can instability be identified?
Synthesis in International orthopaedics, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.
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Who cites it
19 citing papers in PubMed.
- Evaluation, Management, and Return-To-Sport Guidelines for Cervical Spine Injuries in Athletes: A Narrative Review.Global spine journal · 2026Review
- Posterior Fixation Combined with Anterior Transoral Plate Osteosynthesis for Chronic Gehweiler IIIb Atlas Fracture-Dislocation: Case Report and Literature Review.Journal of clinical medicine · 2026Article
- The atlantoaxial distance ratio (AADR): proposal and validation of a novel radiographic parameter for the evaluation vertical atlantoaxial dislocation in a preliminary descriptive study.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Biomechanical effects of the prone stretching and adjusting cervical manipulation : a three-dimensional finite element analysis study.BMC complementary medicine and therapies · 2026Article
- Determining the need for stabilising therapy of cervical spine injuries on CT: towards standardising decision-making in the emergency department.International journal of emergency medicine · 2025Article
- An overview of systematic reviews investigating clinical features for diagnosing neck pain and its associated disorders.The Journal of manual & manipulative therapy · 2025Review
- The Initial Assessment and Management of Cervical Spine Injuries: A Comprehensive Review.Cureus · 2025Review
- Review
- The role of clivus and atlanto-occipital lateral mass height in basilar invagination with or without atlas occipitalization.Neurosurgical review · 2024Article
- The ligamentous cervical instability etiology of human disease from the forward head-facedown lifestyle: emphasis on obstruction of fluid flow into and out of the brain.Frontiers in neurology · 2024Article
- Odontoid fracture in geriatric patients - analysis of complications and outcome following conservative treatment vs. ventral and dorsal surgery.BMC geriatrics · 2023Article
- Cervical Spine Instability Screening Tool Thai Version: Assessment of Convergent Validity and Rater Reliability.International journal of environmental research and public health · 2023Article
- Atlantoaxial Stabilization Using C1 Lateral Mass and C2 Pedicle/Translaminar Screw Fixation by Intraoperative C1- and C2-Direct-Captured Navigation with Preoperative Computed Tomography Images.Asian spine journal · 2023Article
- Pediatric Spine Trauma.Journal of Korean Neurosurgical Society · 2022Article
- Interobserver reliability of the Gehweiler classification and treatment strategies of isolated atlas fractures: an internet-based multicenter survey among spine surgeons.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2022Article
- Pathoanatomy, biomechanics, and treatment of upper cervical ligamentous instability: A literature review.Orthopedic reviews · 2022Review
- A survey on the early management of spinal trauma in low and middle-income countries: From the scene of injury to the diagnostic phase (part II).Brain & spine · 2022Article
- Genetically predicted C-reactive protein mediates the association between rheumatoid arthritis and atlantoaxial subluxation.Frontiers in endocrinology · 2022Article
- Occipitocervical fusion of traumatic atlanto-occipital dissociation in a patient with autofused cervical facet joints: illustrative case.Journal of neurosurgery. Case lessons · 2021Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveThe diagnosis of instability of the injured upper cervical spine remains controversial, due to its complicated anatomical configuration and biomechanical property. Since identifying unstable injuries of the upper cervical spine is essential for immediate stabilizing therapy, this article reviews the current classification systems of upper cervical spine injuries and their statements towards instability.
methodsA systematic review of literature concerning upper cervical spine injuries was performed on the PubMed database from inception to December 2019. An English literature search was conducted using various combinations of keyword terms.
resultsNumerous separate classification systems for each specific injury of the upper cervical spine were obtained. The early classifications are based primarily on injury morphology and mechanism. The recent classifications pay more attention to the investigation of ligamentous status. Various instability criteria were established as well. The determinants involve translation, vertical distraction, angulation, rotation, obliquity of fracture line, comminution, and ligamentous disruption. The status of crucial ligaments plays a key role in determining instability of upper cervical spine injuries. CT scan is more sensitive and reliable than X-ray in detecting misalignment of the upper cervical spine.
conclusionOnly a few classification systems support decision-making concerning instability leading to early operative treatment. The ligamentous integrity is the key element of impacting the stability of the upper cervical spine injuries. The transverse ligament serves as the most crucial element in determining the stability of occipital condyle fractures and atlas fractures as well as atlanto-axial injury. The integrity of anterior longitudinal ligament, disc, and facet joint attributes to the stability of axis fractures. The integrity of tectorial membrane and alar ligaments determines the stability of atlanto-occipital dislocation. The development of a newly classification system concerning ligamentous instability with a high clinical and scientific impact is recommended.
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