Occipitocervical Stabilization

Abstract

The occipitocervical junction, also known as the craniocervical or craniovertebral junction (CVJ), consists of the two joints (the atlanto-occipital and atlantoaxial), the spinal cord, and several neurovascular elements supplying the head and neck. Proper alignment of the occipitocervical junction relies upon several osseous and ligamentous complexes contributing to the aforementioned joints. The interplay of these elements affords stability for this complex anatomical location that functionally allows rotation, flexion, and extension of the cranium in relation to the cervical spine. Historically, in the early 1900s, disruption of the aforementioned structural components, leading to CVJ instability, was not considered amenable to surgical intervention. Over time, treatment strategies have evolved with initial interventions involving only decompression and subsequent strategies also incorporating fusions with stabilization. However, since the first description of an occipitocervical fusion (OCF), by Forrester in 1927, multiple methods of CVJ fixation have been described enabling deformity correction to maintain proper spinal alignment. While OCF is certainly an effective method to address pathology of the occipitocervical junction, given its important role in mobility, posterior fixation must ensure proper sagittal alignment. As such, this chapter discusses the relevant perioperative considerations to attempt to achieve the ideal posture following fixation.