Feasibility of occipital condyle screw placement for occipitocervical fixation: A cadaveric study and description of a novel technique

Juan S. Uribe, Edwin Ramos, Fernando Vale

Research output: Contribution to journalArticle

44 Scopus citations

Abstract

Study Design: Occipital-cervical (OC) stabilization using occipital condyle fixation with a polyaxial screw-rod construct is described. Objectives: To describe a novel technique and initial radiographic results for posterior OC fixation using the occipital condyles for cranial fixation. Summary of Background Data: Stabilization of the OC junction remains a challenge. Owing to the regional anatomy and the poor occipital bone purchase, multiple attachment points to the occipital bone are required to increase construct rigidity. To address these issues, we propose a novel OC fixation technique using polyaxial occipital condyle screws for cranial purchase. Methods: The OC junction was exposed posteriorly in silicone-injected cadaver heads. Polyaxial titanium screws (3.5 mm) were inserted bicortically solely into the occipital condyles; C1 lateral masses and C2 pedicles, or transarticularly through C1-C2, followed by fixation to a 3-mm rod. Drilling was guided by anatomic landmarks and fluoroscopy. Computerized tomography scans were obtained. Condylar screw angles and lengths were analyzed with respect to historical morphometric condyle measurements and with respect to neurovascular structures. Results: The condylar entry point was 4 to 5-mm lateral to the foramen magnum on the axial plane, and 1 to 2-mm rostral to the atlantooccipital joint. The mean angle of medialization was 17 degrees (range: 12 to 22 degrees). In the sagittal plane, the maximal superior screw angulation was 5 degrees. The mean screw length to obtain bicortical purchase was 22 mm (range: 20 to 24 mm). The hypoglossal canal was uninterrupted during its full course. The jugular bulb, carotid, and vertebral arteries were not injured by condyle screw placement. No fractures were identified. Conclusion: Condyle screws can be placed without injury to neurovascular structures. OC junction fixation using polyaxial occipital condyle screws is feasible and can be considered a salvage technique or an alternative where other fixation techniques are not available.

Original languageEnglish (US)
Pages (from-to)540-546
Number of pages7
JournalJournal of Spinal Disorders and Techniques
Volume21
Issue number8
DOIs
Publication statusPublished - Dec 1 2008
Externally publishedYes

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Keywords

  • craniocervical fusion
  • craniocervical junction
  • craniovertebral junction
  • occipital condyle
  • occipital condyle screws
  • occipitocervical fusion
  • occipitocervical instability
  • occipitocervical junction

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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