Fixation techniques of the cervical spine and their relationship to the vertebral artery

Abstract

The anatomy of the upper cervical spine represents a complex system of different structures with various functions. The nervous system maintains probably the most important task in representing the most differentiated connections between the brain and the periphery. The system supply is assured by the vascular system and the more mechanical-oriented (protection, mobility upright posture) tasks of the bony system representing the scaffold. In pathological changes of the upper cervical spine, namely, instability and deformity, surgical intervention with reinforcing implants may help to solve otherwise deleterial problems. The only structure to which these implants can be securely fixed is the bone of the vertebrae, while the other anatomical entities may be severely damaged by misplacement of screws or wires. Since these different anatomical structures are in close vicinity to each other, one of the surgical hazards in this region is the iatrogenic damage. In the atlantoaxial area, the medulla and the vertebral artery are at risk.