Surgical outcome of Occipitocervical Fixation for Craniocervical Instability

Background: The occipitocervical junction is a unique area between the cranium and the upper cervical spine. Treating pathologies of this region require a good knowledge and understanding of the anatomy, biomechanics of this region and nature of the disease. Objective: To evaluate the efficacy of Occipitocervical Fixation (OCF) in patients with craniocervical instability in two tertiary care hospitals. Metrial and Methods: This study was conducted at Combined Military Hospital Rawalpindi and Hayatabad Medical Complex, Peshawar from April 2005 to December 2016. All patients with craniocervical instability were included in our study, and those having occipital bone fractures or previously operated patients with same technique were excluded from this study. The patients were compared using lateral static and dynamic X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively. Results:  A total of 49 cases with craniocervical instability underwent OCF. The mean age of the patients was 40.5 + 1.2 SD years.  There were 31 male patients and 18 female patients. Majority patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.0. At the end of follow-up after surgery, the mean Nurick score was 2.1.  Conclusions: Occipitocervical fixation is a reasonable option to have spinal stability, achieve bone fusion and to get neurological improvement. The procedure can be complicated by certain conditions but these can safely be handled in experience hands.