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Minimally invasive lateral occipitocervical fixation: case series and technique description

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Abstract

Purpose

Occipitocervical junction (OCJ) instability is commonly treated with fixation via open posterior approach. The use of intraoperative navigation allows us to perform occipitocervical fixation via minimally invasive approach. We report a series of patients treated with percutaneous occipitocervical fixation, describing the surgical procedure in detail and discussing the technique.

Methods

We prospectively enrolled 8 patients affected by OCJ instability secondary to trauma and rheumatoid arthritis. Traumatic patients were preoperatively evaluated with CT scan and MRI scan if needed. Rheumatoid arthritis group was evaluated with both CT and MR. Patients underwent percutaneous occipitocervical fixation with the assist of intraoperative 3D imaging and navigation. All patients were functionally and radiologically evaluated pre-, at 6 weeks, and at 1 year postoperatively.

Results

Percutaneous occipitocervical fixation was successfully performed in all of the patients. 33 screws were placed. 29 (87.88%) were placed without any pedicle breach. In 3 (9.09%) screws we observed a minor; and in 1 (3.03%) screw we observed a major pedicle breach. We did not have any postoperative complications.

Conclusions

Described method of occipitocervical fixation is a minimally invasive method that has a similar outcome to the open technique. It requires the experience in open techniques and the assist of intraoperative 3D imaging and navigation to be performed efficiently.

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Funding

The manuscript was not funded by any entity. The material and methods are designed by the authors of the paper.

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Authors and Affiliations

  1. Department of Neurosurgery, Copernicus Hospital Gdansk, ul. Nowe Ogrody 1-6, 80-803, Gdansk, Poland

    Stanisław Adamski, Mateusz M. Węclewicz & Wojciech Kloc

  2. Department of Orthopedic Surgery, Medical University of Gdansk, ul. Nowe Ogrody 1-6, 80-803, Gdansk, Poland

    Marek Rocławski & Rafał Pankowski

  3. Department of Psychology and Sociology of Health and Public Health School of Collegium Medicum, University of Warmia - Mazury in Olsztyn, ul. Warszawska 30, 10-082, Olsztyn, Poland

    Wojciech Kloc

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  1. Stanisław Adamski
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  2. Mateusz M. Węclewicz
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  4. Rafał Pankowski
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Correspondence to Mateusz M. Węclewicz.

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Adamski, S., Węclewicz, M.M., Rocławski, M. et al. Minimally invasive lateral occipitocervical fixation: case series and technique description. Eur Spine J 31, 2714–2722 (2022). https://doi.org/10.1007/s00586-022-07278-9

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  • DOI: https://doi.org/10.1007/s00586-022-07278-9

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