Initial Management at Presentation
- Occipitocervical instability: Posterior occipitocervical fusion with O-C2 instrumentation and rib autograft is indicated.
- Atlantoaxial instability: Posterior C1-2 instrumentation and fusion with allograft and bone morphogenetic protein is most desirable, although autograft can be used. Instrumentation includes either C1-2 transarticular screw fixation or C1 lateral mass/C2 pars construct.
- Subaxial cervical instability: Either posterior or anterior cervical instrumentation and fusion are indicated.
Adjunctive Therapies
- Physiotherapy: Aside from the possible need for physical therapy, no adjunctive therapies are generally required.
Follow-up
- Occipitocervical instability: Plain films are obtained 1 and 2 months postoperatively. Cervical CT is obtained 4 months postoperatively to document fusion.
- Atlantoaxial instability: Plain films are obtained 1, 2, and 3 months postoperatively to document fusion.
- Subaxial cervical instability: Plain films are obtained 1, 2, and 3 months postoperatively to document fusion.
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