ABSTRACT
I INTRODUCTION Craniocervical junction injuries have traditionally had a high rate of mortality, with most patients dying before making it to a hospital. There is an increasing prevalence of patients surviving these injuries long enough to make it to emergency rooms because of improvements in trauma care in the field by emergency medical services. Also, improvements in diagnostic imaging may lead to more recognition of these injuries, especially in patients with subtle ligamentous injuries and incomplete dislocations (Fig. 1). The instability created by occipitoatlantal dislocations and subluxations, as well as from certain occipital condyle fractures, is best stabilized by occipito-cervical fusion. In 1927, Foerster (1) described the use of a fibula for occipito-cervical fusion, and subsequently many techniques have been described with (2-7) and without (8,9) internal fixation. Internal fixation has included wires and, more recently, plates or rods. The purpose of this chapter is to review some of the more common techniques of occipito-cervical fusion used in the treatment of occipito-cervical instability due to trauma.
