Surg Neurol
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A single-institution series of injuries of the upper cervical spine are analyzed retrospectively and the literature relevant to the topic is reviewed. ⋯ Candidates for surgery as the primary treatment include those with isolated ligamentous instabilities, Type III hangman's fractures and Type II odontoid fractures with dislocation more than 5 mm. In combined C1/C2 fractures the axis fracture dictates the treatment strategy. Patients who undergo dorsal procedures and have involvement of C1 have a greater chance of developing persistent pain.