Occipito-cervical fusion using posterior titanium plates

Occipito-cervical fusion may be indicated for instability of the occipito-cervical junction or atlanto-axial spine secondary to a wide spectrum of pathology. Many techniques exist to stabilize the spine until fusion is achieved. Recent reports of plate fixation have been favorable. In this study we set out to determine the effectiveness and advantages of titanium plate fixation when used to stabilize the occipito-cervical junction. Thirteen patients with occipito-cervical instability or atlanto- axial instability underwent occipito-cervical fusion using posterior titanium plates. The plates were contoured to the occipito-cervical junction and fastened to the skull with screws, and to the spine with lateral mass screws. The patients were followed prospectively clinically and radiographically to a minimum of 24 months. Outcome parameters included peri-operative morbidity and complications, hardware integrity, spinal alignment, fusion, and neurological status. Twelve of thirteen patients went on to solid fusion radiologically and clinically, and recovered or improved from their myelopathy. One patient did not. Three patients had radiographic evidence that two screws were loose and one screw was broken. There were no instances of plate breakage. We conclude that titanium plate fixation of the occipito- cervical junction is versatile and stable. The plates maintain axial correction and allow for future MR imaging.