1. Wires and rods. Sublaminar, interspinous or interfacet wires may be used alone (Gallie and Brooke techniques) or with posterior metal rods, triangles or rectangles (Hartshill). Bone graft is added for posterior fusion and stabilization.
2. Plates and screws. Occipitocervical plates extend stabilization of the upper cervical spine to the occiput, and are secured to the skull with short screws. Lateral mass plates are applied to the posterior aspect of the lateral masses, and require very precise (CT-guided) screw/hook placement (lateral angulation of 30°) to avoid the vertebral artery.
Transarticular 3.5 mm cortical screws (Magerl) may be used to stabilize C1-C2.
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