The purpose of this paper was to prospectively evaluate the safety and efficacy of a new implant system, which allows for a combination of screws and sublaminar hooks, in patients with traumatic, metastatic and degenerative diseases of the cervical and upper thoracic spine. The stabilizing levels and implants used are shown in Table 1 . The position of hooks and screws on the postoperative radiographs and the follow-up examination were carefully interpreted to identify implant loosening or breakage. A special rod is designed for fixation to the occiput. One end of the rod is flattened to a plate, and it can be contoured and fixed to the occiput with screws.
Hooks are available with two offsets.
A cross-linking device and parallel connectors are available, allowing connection to rods with the same size or larger diameter rods. The remaining 12 patients with traumatic lesions were followed for between 7 and 28 months. In four cases, an additional anterior fusion was performed with tricortical bone graft from the anterior iliac crest, stabilized with an anterior cervical plate in three cases. The two patients who were neurologically intact, and eight of the nine patients with upper extremity radiculopathies, were normal at follow-up, while one was unchanged. One of the two patients with quadriparesis was unchanged and one was slightly improved.