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A New Technique for Intraoperative Reduction of Occipitocervical Instability

Hsu, Wesley MD; Zaidi, Hasan A. MD; Suk, Ian BSc, BMC; Gokaslan, Ziya L. MD; Wolinsky, Jean-Paul MD

doi: 10.1227/01.NEU.0000369925.81522.60

BACKGROUND: Occipitocervical instability with vertical migration of the odontoid is a rare but potentially debilitating anomaly of the craniocervical junction. Anterior decompression by means of a transoral or transcervical approach followed by posterior instrumentation commonly is used to treat this pathology.

OBJECTIVE: To develop an innovative operative technique to correct reducible occipitocervical instability using a purely posterior approach.

CLINICAL PRESENTATION: Two patients presented to our institution with occipitocervical instability. One patient developed vertical migration of the odontoid secondary to a retropharyngeal abscess after radiation treatment. The second patient developed occipitocervical instability as a result of pathological destruction of C2 from a breast metastasis. Both patients were myelopathic with severe neck pain.

TECHNIQUE: Both patients were brought to the operating room for intraoperative reduction and fixation using a purely posterior approach. This new technique obviated the need for an anterior decompression procedure or preoperative halo reduction. Postoperatively, both patients had excellent restoration of spinal alignment as well as improvement in both pain and myelopathy.

CONCLUSION: We achieved intraoperative reduction of occipitocervical instability through a purely posterior approach. This technique adds a tool to the armamentarium of techniques used for the treatment of occipitocervical instability.

Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Maryland ()

Reprint requests: Wesley Hsu, MD, Department of Neurosurgery, The Johns Hopkins University School of Medicine, Meyer Bldg. 8–161, 600 N. Wolfe St., Baltimore, MD 21287. E-mail:

Received, May 4, 2009.

Accepted, November 28, 2009.

Copyright © by the Congress of Neurological Surgeons