Posterior Instrumentation for Occipitocervical Fusion

George Sapkas 1, Stamatios A Papadakis*, 2, Dimitrios Segkos 2, Konstantinos Kateros 3, George Tsakotos 2, Pavlos Katonis 4
1 A’ Department of Orthopaedics, Medical School of Athens University, "Attikon" University Hospital, Haidari, Greece
2 D’ Department of Orthopaedics, “KAT” General Hospital, Kifissia, Greece
3 Department of Orthopaedics, “G. Gennimatas” General Hospital, Athens, Greece
4 Department of Orthopaedics, Medical School of Herakleion University, Crete, Greece

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© Sapkas et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the 28th Octovriou Str. 54, 15236 N. Pendeli, Greece; Tel: +30 6944 297086; Fax: +30 210 61 37 145; E-mail:


Since 1995, 29 consecutive patients with craniocervical spine instability due to several pathologies were managed with posterior occipitocervical instrumentation and fusion. Laminectomy was additionally performed in nineteen patients. The patients were divided in two groups: Group A which included patients managed with screw-rod instrumentation, and Group B which included patients managed with hook-and-screw-rod instrumentation. The patients were evaluated clinically and radiographically using the following parameters: spine anatomy and reconstruction, sagittal profile, neurologic status, functional level, pain relief, complications and status of arthrodesis. The follow-up was performed immediately postoperatively and at 2, 6, 12 months after surgery, and thereafter once a year. Fusion was achieved in all but one patient. One case of infection was the only surgery related complication. Neurological improvement and considerable pain relief occurred in the majority of patients postoperatively. There were neither intraoperative complications nor surgery related deaths. However, the overall death rate was 37.5% in group A, and 7.7% in group B. There were no instrument related failures. The reduction level was acceptable and was maintained until the latest follow-up in all of the patients. No statistical difference between the outcomes of screw-rod and hook-and-screw-rod instrumentation was detected. Laminectomy did not influence the outcome in either group. Screw-rod and hook-and-screw-rod occipitocervical fusion instrumentations are both considered as safe and effective methods of treatment of craniocervical instability.

Keywords: Occipitocervical fusion, craniocervical instability, spine, reconstruction, posterior procedures.