Only a few classification systems support decision-making concerning instability leading to early operative treatment. CT scan is more sensitive and reliable than X-ray in detecting misalignment of the upper cervical spine. The status of crucial ligaments plays a key role in determining instability of upper cervical spine injuries. The determinants involve translation, vertical distraction, angulation, rotation, obliquity of fracture line, comminution, and ligamentous disruption. Various instability criteria were established as well. The recent classifications pay more attention to the investigation of ligamentous status. The early classifications are based primarily on injury morphology and mechanism. Numerous separate classification systems for each specific injury of the upper cervical spine were obtained. An English literature search was conducted using various combinations of keyword terms. MethodsĪ systematic review of literature concerning upper cervical spine injuries was performed on the PubMed database from inception to December 2019. Since identifying unstable injuries of the upper cervical spine is essential for immediate stabilizing therapy, this article reviews the current classification systems of upper cervical spine injuries and their statements towards instability.

The diagnosis of instability of the injured upper cervical spine remains controversial, due to its complicated anatomical configuration and biomechanical property.

3d x ray upper cervical spine