Posterior stabilization of the cervical spine.

Operative management of the patient with cervical spinal instability depends on the specific anatomy and location of the injury. The unique features of the atlanto-axial complex require stabilizing procedures that are quite different from those used in the subaxial spine. A clear idea of the etiology of the instability, a definition of the pathological anatomy, and knowledge of the presence and extent of neural compression are essential for optimizing a successful outcome. In some instances the clinical circumstances mandate the use of an anterior approach, and in others a posterior operation is more appropriate and likely to be successful. In the majority of patients instability can be successfully managed utilizing either an anterior or a posterior approach. Even when a posterior approach is used, there is usually more than one surgical option. It cannot be emphasized too strongly, however, that the surgeon should choose the procedure with which he or she is most comfortable and which he or she is technically able to perform. It makes little sense to attempt a procedure such as C1-C2 transarticular screw fixation or posterior cervical plating without having had "hands on" experience with cadavers or anatomical models or having previously assisted in the procedure. Wiring and other means of fixation, although "less modern," have been used successfully for many years and are usually quite satisfactory if the surgeon is experienced and comfortable in their use.