Despite 50 years of neurosurgical experience, occipitocervical fusion continues to present a technical challenge to the surgeon. Traditional nonrigid techniques applied in the occiput and cervical spine often fail secondary to postsurgical cranial settling or rotational deformity. Unlike widely used nonrigid and semirigid techniques, rigid fixation of the craniocervical junction should allow correction of deformity in any plane, provide immediate stability without need for external orthosis, and prevent cranial settling.
Since 1992, the senior author (D.W.C.) has used a rigid plate and screw fixation system for occipitocervical fusions. The technique proved to be more difficult than expected, and the procedure has evolved as experience was gained. The authors present a series of 24 patients and a technique that now involves the use of a custom-designed T-plate that is attached to the midline occipital "keel" at one end and to the spine at the other end by means of screw-fixed plates.
Although it is still evolving, the current technique for obtaining rigid occipitocervical fixation allows for immediate rigidity and stability of the spine without the use of an external orthosis (that is, in the absence of osteoporosis), may be extended to any level of the spine, may be used in the absence of posterior elements, prevents postsurgical cranial settling and restenosis, facilitates reduction of the spinal deformity in any plane, and sometimes eliminates the need for an anterior (transoral) decompressive procedure.