Rigid occipitocervical fusion

Abstract

For more than 50 years occipitocervical fusion has been performed for the management of craniocervical instability. Despite advances in technology, craniocervical fixation continues to be a technical challenge to the spine surgeon. The complex anatomy of the region and the frequent need for anterior and/or posterior decompressive procedures represent a mechanical disadvantage and are associated with a high failure rate. Numerous methods for spinal fixation have been developed, but none has gained widespread popularity. The use of plates and screws to obtain rigid fixation of the craniocervical junction is desirable because it allows correction of deformity, provides immediate stability, and precludes cranial settling. The technique is demanding and sometimes fraught with complications. Since 1992, the senior author (D.W.C.) has used a rigid plating technique to treat patients with craniocervical instability. This procedure proved more difficult than expected, and the operative procedure has evolved as experience has been gained. The authors present a series of 24 patients and describe a technique that, in their experience, decreased the complication rate and improved the fusion rate. The technique involves a custom-designed "T-plate" that is attached to the midline occipital bone and to the cervical spine with lateral mass plates.