Internal Fixation of the Cervical Spine: Current Indications and Techniques

Numerous techniques for the internal fixation of the cervical spine have been developed in recent years. The indications for surgery must be strictly defined before the optimal type of implant can be selected on the basis of the advantages and potential risks. Wiring techniques are still commonly used for posterior stabilization. Anterior fusion can be accomplished without internal fixation in most cases. The halo vest is still widely used for the conservative management of cervical fractures and for postoperative external immobilization. Posteriorly, traditional wiring methods are still used, as well as newer techniques, such as C1-C2 screw fixation, occipitocervical plate fixation, and lateral-mass lower cervical plating. Anteriorly, meticulous Smith-Robinson surgical approach and grafting techniques are essential. Further studies are needed to define the exact indications for various new techniques, such as anterior odontoid screw fixation and anterior plating. The surgeon must choose an appropriate device on the basis of the mechanism of injury, the pathoanatomy of the lesion, and familiarity with the device, keeping in mind the goals of internal fixation-stabilization, reduction and maintenance of alignment, early rehabilitation, and perhaps enhancement of fusion and avoidance of the need to use an external halo vest.