Revision Upper Cervical Spine

Revision surgeries for failed odontoid treatments pose a unique challenge to the treating surgeon due to the complex and special anatomy manifested as thin and irregular bony corridors, significant physiologic motion, and the significant contribution of the ligamentous structures to the stability of the occiput-C2 segment. Failures can be classified into two major categories depending on whether or not appropriate initial management was administered. Inadequate surgical technique or incomplete understanding of the patho-anatomy are the most common reasons for failure of the initial procedure. Posterior C1-2 fusion, preferably with a technique different than the original surgery, is the treatment of choice for most failed odontoid fracture surgeries.