1. Spectrum of pathology Prolapsed discs and osteophytic compression; wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory subluxation Neoplastic: meningiomas, schwannomas, metastatic cord compression Congenital Klippel Feil, fused, Downs, enterogenous cysts

2. 43 yr male, brachalgia C5 right

6. Spectrum of pathology Prolapsed discs, osteophytic compression: wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory subluxation Neoplastic: meningiomas, schwannomas, metastatic cord compression Congenital Klippel Feil, fused, Downs, enterogenous cysts Infection: discitis, osteomyelitis, epidural abscess

7. S.R. - Male, Age 77 Severe Rheumatoid Arthritis Past multiple joint replacements and episodes of steroid Px Progressive upper and lower limb long tract symp/signs Neck Pain and Stiffness

10. Occipitocervical fixation

11. Halo support post-op

13. Sub axial rheumatoid deformity

14. Seronegative arthritis

15. Ankylosing spondylitis

16. Spectrum of pathology Prolapsed discs, osteophytic compression: wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory subluxation Neoplastic: meningiomas, schwannomas, metastatic cord compression Congenital Klippel Feil, fused, Downs, enterogenous cysts Infection: discitis, osteomyelitis, epidural abscess

17. Odontoid fracture

18. Odontoid screw fixation

19. Hangmans fracture

20. C6 Crush fracture, posterior ligamentous injury

21. Interspinous ligamentous disruption

22. Hyperextension injury, ALL disrupted

23. Rotatory subluxation

26. Pre reduction MR

36. Interspinous ligamentous disruption

37. Posterior reduction and fixation techniques Currette or hook Drilling/ nibbling the superior aspect of the inferior facet Wires Hooks or clamps Screws/ Plates Screws/ Rod combinations

39. Spectrum of pathology Prolapsed discs, osteophytic compression: wear and repair Inflammatory: rheumatoid, ankylosing spondylitis Trauma: odontoid, rotatory subluxation Neoplastic: meningiomas, schwannomas, metastatic cord compression Congenital Klippel Feil, fused, Downs, enterogenous cysts Infection: discitis, osteomyelitis, epidural abscess

43. Ependymoma Gd 2

44. 51 years neck, arm pain

45. NHL cervical cord compression

46. CT pelvis: right inguinal lymphadenopathy

47. 2 years post op

48. Patchell, Lancet 2005

49. Complications General (DVT, MI, Infection, haematoma) Specific: Recurrent and sup laryngeal n Dysphasia Retropharyngeal haematoma Nerve root injury Spinal cord injury Vertebral artery injury

50. The future Better analysis of results Better constructs Clearer indications More work Ceramic vs plastics vs metal Interface with bone Bone growth stimulants Genetically engineered solutions