Odontoid remodeling with occipital condyle stabilization in patients with metastatic C2 involvement

The occipitocervical junction (OCJ) is a complex anatomical region crucial for protecting the lower brain stem, upper spinal cord, and lower cranial nerves. Instability in this area can lead to severe outcomes such as chronic pain, neurological deficits, or death. Various surgical techniques have been developed for OCJ stabilization, particularly using occipital condyle screws, which have shown promise in providing stability and preserving neck rotation. This article presents two cases of OCJ instability caused by metastatic involvement of the C2 vertebra, managed successfully with occipital condyle screw fixation. The first case involved a 22-year-old female with Ewing sarcoma metastasis, and the second case involved a 62-year-old male with multiple myeloma. Both patients exhibited significant improvements in neurological function and cervical stability postoperatively, with observable den remodeling. Our findings suggest that occipital condyle screw fixation is not only feasible but also effective in managing OCJ instability due to metastatic disease. Detailed preoperative evaluation and the use of advanced intraoperative imaging technologies, such as the O-arm and neuronavigation, are essential for maximizing safety and ensuring optimal outcomes. This study underscores the potential of occipital condyle screw fixation as a primary surgical method for stabilizing the OCJ in appropriate cases.