Occipitocervical Fusion: An Updated Review

  • Nabeel S. Ashafai
  • Massimiliano Visocchi
  • Norbert Wąsik
Part of the Acta Neurochirurgica Supplement book series (NEUROCHIRURGICA, volume 125)


Occipitocervical fusion (OCF) is indicated for instability at the craniocervical junction (CCJ). Numerous surgical techniques, which evolved over 90 years, as well as unique anatomic and kinematic relationships of this region present a challenge to the neurosurgeon. The current standard involves internal rigid fixation by polyaxial screws in cervical spine, contoured rods and occipital plate. Such approach precludes the need of postoperative external stabilization, lesser number of involved spinal segments, and provides 95–100% fusion rates. New surgical techniques such as occipital condyle screw or transarticular occipito-condylar screws address limitations of occipital fixation such as variable lateral occipital bone thickness and dural sinus anatomy. As the C0–C1–C2 complex is the most mobile portion of the cervical spine (40% of flexion-extension, 60% of rotation and 10% of lateral bending) stabilization leads to substantial reduction of neck movements. Preoperative assessment of vertebral artery anatomical variations and feasibility of screw insertion as well as visualization with intraoperative fluoroscopy are necessary. Placement of structural and supplemental bone graft around the decorticated bony elements is an essential step of every OCF procedure as the ultimate goal of stabilization with implants is to provide immobilization until bony fusion can develop.


Occipitocervical fusion Occipitocervical fixation Surgical techniques 


Competing Interests

The authors declare that they have no competing interests.

Compliance with Ethical Standards

No financial support was received for this work.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Nabeel S. Ashafai
    • 1
  • Massimiliano Visocchi
    • 2
  • Norbert Wąsik
    • 1
    • 3
  1. 1.Alshafai Neurosurgical Academy (ANA)TorontoCanada
  2. 2.Institute of Neurosurgery Catholic University of RomeRomeItaly
  3. 3.Department of NeurosurgeryPoznan University of Medical SciencesPoznanPoland

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