Advance in research on anterior occipitocervical fixation and fusion

Abstract

The stability of the occipitocervical region mainly depends on the integrity of the bony structure, surrounding ligaments and joint capsules. The instability of this region often leadsto the clinical symptoms of compression injury of nerve and vascular, which requires early surgical intervention to rebuild its stability. Posterior occipitocervical fixations are main surgical treatment for the occipitocervical diseases. However, the posterior fixations are not suitable for some patients with congenital or iatrogenic causes. Recently, the anterior occipitocervical fixation with the screws anchored at clivus or into the occipital condyles have been used for the following operations. 1. Anterior bone graft fusion. One case which was performed by oral approach was reported well fusion, but the stability was poor and there was a possibility of displacement. 2. Anterior shaped titanium cage and plate fixation. The literatures reported that this anterior operation was completed in 35 cases by oral, oral combined with mandibulotomy, and anterior retropharyngeal approaches. This fixation has a good biomechanical stability and is widely used in clinical applications, including occipitocervical tumors and deformities. And the complications including intraoperative vascular, spinal and dural injuries, postoperative drinking cough, non-fusion, deep infection, and death. 3. Anterior occipital-atlantoaxial joint screw fixation. Seven cases were performed by anterior occipital-atlantoaxial joint screw fixation through anterior percutaneous approach. This fixation is less trauma, but required precise placement of screw and not conducive bone fusion, and it is suitable for traumatic instability of the upper cervical spine, atlantoaxial dislocation and basilar invagination. Each procedure of anterior occipitocervical fixation is not suitable for all patients, and it should be adopted according to the patient's condition, surgical hardware conditions and the surgeon's habits.