Advancements in occipitocervical fusion: Biomechanical insights, surgical techniques, and clinical outcomes

Occipitocervical fusion (OCF) has been performed for over 70 years to address craniocervical instability caused by trauma, tumors, or congenital anomalies. Despite technological advances, challenges persist due to the unique anatomy, high mobility, and complex pathological processes at the occipitocervical junction. This study aimed to evaluate clinical, radiographic, and surgical outcomes of OCF in patients with craniocervical instability.

A 2-year cohort study was conducted at Dr. Saad Alwitry's Neurosciences Hospital (April 2021- March 2023) involving 45 patients aged 17-53 (mean age 35.6). Inclusion criteria required radiologically confirmed instability, psychological fitness, and a normal coagulation profile. Patients with advanced rheumatoid arthritis or prior posterior fossa surgery were excluded. OCF procedures were performed using modern rigid instrumentation, including plates and rods, and outcomes were monitored using radiographic fusion assessments and clinical evaluations.

All patients achieved solid fusion (100%) within a mean of 7.06 months (range 5-9 months). Myelopathy and neurological deficits were present in all patients preoperatively, while neck pain affected 73.3%. Postoperatively, 73.3% of patients showed improvement in myelopathic symptoms, and all patients reported resolution of neck pain. Complications included one transient neurological deterioration, one wound infection, and one cerebrospinal fluid leak, all managed successfully. No operative mortalities or vascular injuries occurred.

Rigid occipitocervical fixation stabilizes the craniocervical junction, achieving high fusion rates and symptom resolution with minimal complications. Thorough preoperative planning, precise surgical technique, and an understanding of craniocervical anatomy are crucial for optimal outcomes.