Contemporary posterior occipitocervical fixation techniques

Purpose of review Rigid posterior occipital cervical fixation and fusion are essential in cases of occipitocervical instability. Instability of the occipitocervical junction can lead to compression of the spinal cord and medulla, which may result in pain, cranial nerve dysfunction, paresis and paralysis, respiratory distress, or even sudden death. Although the majority of the patients of occipitocervical instability require operative stabilization, the complications of surgery can be serious. Instrumentation techniques, bone grafting, and imaging have evolved over the years. The purpose of this review is to describe the recent evolution in techniques of occipitocervical fusion and provide a description of our preferred method of fixation. Recent findings Plate-rod-screw constructs have become more versatile, more stable, and less complicated. Improved independent occipital plate systems allow for bilateral contoured rod fixation from the plate to the cervical spine. Current instrumentation systems can accommodate a wide range of anatomical variation. Summary Posterior occipitocervical fixation techniques have significantly evolved to modern, advanced rod-screw-independent occipital plate systems. Current implants allow for stable fixation, higher fusion rates, and improved clinical results. Modern techniques require a thorough understanding of spinal anatomy. Advances in spinal imaging have improved the safety and efficacy of complicated instrumentation techniques.