Review and evolution of occipital fixation devices and techniques

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Spinal Surgery

Background:

• Occipital-cervical (OC) fixation addresses craniocervical junction (CCJ) instability, presenting unique anatomical and pathological challenges.
• Significant advancements in OC fixation techniques have occurred since the 1990s, impacting fusion rates, motion, and usability.

Purpose of the Study:

• To review and categorize modern occipital-cervical fixation techniques.
• To analyze the evolution and current trends in OC fixation methods.

Main Methods:

• Manual literature review of OC fixation techniques using MEDLINE database.
• Categorization of fixation methods including sublaminar wiring, plate-based constructs, screw-rod constructs, occipital condyle screws, and C1-occipital transarticular screws.

Main Results:

• Patient outcomes are similar between modern plate-based and non-plate-based fixation systems.
• Surgeon preference, ease of use, and patient anatomy are key determinants in technique selection.
• Modular plate-based and eyelet screw systems are increasingly popular due to adaptability.

Conclusions:

• The choice of OC fixation technique depends on surgeon expertise and patient-specific factors.
• Specialized screws serve as valuable options for complex cases or salvage situations.
• Future developments may include patient-specific 3-D printed implants for challenging OC instability cases.