Occipitocervical fusion via occipital condylar fixation: A clinical case series

Study Design: Retrospective review/case series. Objective: This study aims to present the clinical feasibility of condylar fixation in occipitocervical (OC) fusion. Here, we present the largest clinical series to date of patients who underwent OC fusion via cervicocondylar fixation using a polyaxial screw/rod construct. SUMMARY OF BACKGROUND DATA: The novel technique using the occipital condyles as the sole cranial fixation point has been described. Both cadaveric and biomechanical studies, in recent literature, have shown technical feasibility and surgical safety of condylar fixation. METHODS: We retrospectively reviewed a prospectively acquired database of all patients treated with OC fusion via cervicocondylar fixation at our institution between 2007 and 2011. All patients were scheduled for follow-up postoperatively at weeks 2, 6, 12, 24, and annually thereafter. Outcome measures included estimated blood loss, operative time, complications, integrity of the construct, and fusion rates. Exclusion criteria included condylar fracture, previous cervical fusion, or vertebral artery injury. Enrolled patients subsequently underwent posterior OC fixation using occipital condyle, C1 lateral mass, and/or C2 pars interarticularis screw fixation. Subaxial cervical fixation consisted of lateral mass screw placement. Intraoperative fluoroscopy and hypoglossal monitoring were used. Results: We identified 12 consecutive patients who underwent OC fusion using the occipital condyle as the cranial fixation point using polyaxial screws. The mean operative time was 283 minutes (192-416). The mean total blood loss was 229 mL (100-400). Mean follow-up was 21.4 months (4-39). One patient suffered from a superficial wound infection. There were no neural or vascular complications. Radiographic evidence of OC fusion was noted for all patients with >6-month follow-up. Conclusions: OC fusion using occipital condylar screws is a feasible alternative to current occipital plate fixation. Condylar screw fixation can be performed safely with successful arthrodesis as a treatment for OC instability in patients.