Transoral gunshot wounds to the atlanto-axial complex: report of five cases.

Although there has been a rise in the incidence of gunshot wounds to the spine in the United States, involvement of the upper cervical spine, i.e., the atlanto-axial complex, remains rare. Management strategies for these types of injuries come from wartime as well as civilian experience, however, they are not uniformly agreed upon. Treatment strategies are aimed at both stabilization of bony structures and preservation of neurologic function. This report documents five neurologically intact patients who sustained gunshot wounds to the atlanto-axial complex, their management, and follow-up results.