Minimally invasive lateral occipitocervical fixation: case series and technique description

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Occipitocervical junction (OCJ) instability traditionally requires open posterior fixation.
• Minimally invasive techniques are emerging for spinal procedures.
• Intraoperative navigation enhances precision in complex spinal surgeries.

Purpose of the Study:

• To describe and evaluate a minimally invasive approach for occipitocervical fixation.
• To assess the feasibility and outcomes of percutaneous occipitocervical fixation using intraoperative navigation.
• To compare the minimally invasive technique with traditional open approaches.

Main Methods:

• Prospective enrollment of 8 patients with OCJ instability (trauma or rheumatoid arthritis).
• Preoperative imaging included CT and MRI as indicated.
• Percutaneous occipitocervical fixation performed with intraoperative 3D imaging and navigation.
• Postoperative functional and radiological evaluation at 6 weeks and 1 year.

Main Results:

• Successful percutaneous occipitocervical fixation in all patients.
• 33 screws placed with a high rate of accuracy (87.88% without pedicle breach).
• No postoperative complications reported.

Conclusions:

• Percutaneous occipitocervical fixation is a viable minimally invasive option for OCJ instability.
• The technique demonstrates comparable outcomes to open fixation.
• Requires surgical expertise and intraoperative navigation for efficient execution.