Indications for surgery and stabilization techniques of the occipito-cervical junction

Occipito-cervical (OC) instrumentation and fusion is indicated in traumatic atlanto-occipital dissociation and type III Anderson-Montesano occipital condyle fractures. The goals of surgery are to stabilize the mechanically compromised OC junction, correct deformity or displacement, and decompress compromised neural structures. The goals of instrumentation are to provide immediate stability, improve fusion rate, diminish the need for postoperative external immobilization, and decrease rehabilitation time. To successfully instrument the occipito-cervical spine, a working knowledge of the anatomy of the occipital-cervical junction is imperative. A wide variety of stabilization techniques and instrumentation systems are currently available, each with its own advantages and disadvantages. With familiarity of the constraints and benefits of the available instrumentation systems, the individual fixation needs of a clinical situation can be fulfilled and successful patient outcomes can be achieved.