Occipitocervical Fusion: Indications and Techniques

ABSTRACT

The craniocervical junction can be affected by a wide array of disease processes. Surgical options to treat craniocervical instability are similarly diverse. Several constructs have been developed over the years, ranging from simple onlay bone grafts to more complex constructs using a variety of rods, plates, and screws. This article reviews the several different constructs currently available for occipitocervical fusion. The advantages and disadvantages of each type of construct are discussed. The type of construct used will depend on the specific disease process and the experience and preferences of the surgeon.

KEYWORDS

Craniocervical instability - occipitocervical fusion - spine surgery

REFERENCES

• 1 Sakou T, Kawaida H, Morizono Y, Matsunaga S, Fielding J W. Occipitoatlantoaxial fusion utilizing a rectangular rod.  Clin Orthop . 1989;  239 136-144
• 2 Pilcher L S. Atlo-axoid fracture dislocation.  Ann Surg . 1910;  51 208-211
• 3 Foerster O. Die leitungsbahnen des Schmerzgefühls und die chirurgische Behandlung der Schmerzzustände.  Berlin: Urban and Schwarzenberg 1927: 265-268
• 4 Khan E A, Yglesias L. Progressive atlanto-axial dislocation.  JAMA . 1935;  105 348-352
• 5 Cone W, Turner W G. The treatment of fracture-dislocations of the cervical vertebrae by skeletal traction and fusion.  J Bone Joint Surg . 1937;  19[Am] 584-602
• 6 Grantham S A, Dick H M, Thompson R C, Stinchfield F E. Occipitocervical arthrodesis: indications, technique and results.  Clin Orthop . 1969;  65 118-129
• 7 Wertheim S B, Bohlman H H. Occipitocervical fusion: indications, technique, and long-term results in thirteen patients.  J Bone Joint Surg Am . 1987;  69A 833-836
• 8 Malcom G P, Ransford A O, Crockard H A. Treatment of non-rheumatoid occipitocervical instability.  J Bone Joint Surg Br . 1994;  76 357-366
• 9 Ransford A O, Crockard H A, Pozo J L. Craniocervical instability treated by contoured loop fixation.  J Bone Joint Surg Br . 1986;  68 173-177
• 10 Moskovich R, Crockard A, Shott S. Occipitocervical stabilization for myelopathy in patients with rheumatoid arthritis.  J Bone Joint Surg Am . 2000;  82 349-365
• 11 Apostolides P J, Dickman C A, Golfinos J G. Threaded Steinmann pin fusion of the craniovertebral junction.  Spine . 1996;  21 1630-1637
• 12 Fehlings M G, Errico T, Cooper P. Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation.  Neurosurgery . 1993;  32 198-208
• 13 Smith M D, Anderson P, Grady M S, Benjamin V, DiBartolo T. Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique.  Spine . 1993;  18 1984-1990
• 14 Vale F L, Oliver M, Cahill D W. Rigid occipitocervical fusion.  J Neurosurg (Spine 2) . 1999;  91 144-150
• 15 Grob D, Dvorak J, Panjabi M, Froelich, Hayek J. Posterior occipitocervical fusion. A preliminary report of a new technique.  Spine . 1991;  16(suppl) S17-S23
• 16 Brattström J, Granholm L. Atlanto-axial fusion in rheumatoid arthritis. A new method of fixation with wire and bone cement.  Acta Orthop Scand . 1976;  47 619-628
• 17 Clark C R, Keggi K J. Stabilization of the cervical spine using methylmethacrylate.  Orthop Trans . 1980;  4 41-42
• 18 Bryan W J, Inglis A E, Sculco T P, Ranawat C S. Methylmethacrylate stabilization for enhancement of posterior cervical arthrodesis in rheumatoid arthritis.  J Bone Joint Surg Am . 1982;  64 1045-1050