Original ArticlesRole of Onlay Grafting with Minimal Internal Fixation for Occipitocervical Fusion in Oncologic PatientsSanpakit, Sanyapong*; Mansfield, Frederick L.†; Liebsch, Norbert J.‡Author Information *Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; †Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital; and ‡Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, U.S.A. Received March 24, 1999; accepted February 15, 2000. Address correspondence and reprint requests to Dr. F. L. Mansfield, Zero Emerson Place, Suite 120, Boston, MA 02114, U.S.A. Journal of Spinal Disorders: October 2000 - Volume 13 - Issue 5 - p 382-390 Buy Abstract The choice of fixation for occipitocervical arthrodesis remains controversial, especially in oncologic patients who need further radiographic evaluation or postoperative radiotherapy. We studied the long-term outcome of 20 patients who underwent occipitocervical fusions using onlay corticocancellous bone graft and wiring, with postoperative halo vest immobilization. Eight of these patients had postoperative radiotherapy for spinal tumors (group I), and 12 patients had occipitocervical fusions for other pathologies that did not require postoperative radiotherapy (group II). All patients had solid arthrodeses; however, there was a difference in the average time to fusion between patients who received pre-or postoperative radiotherapy and those who did not (p = 0.11). At an average follow-up of 54.5 months (range 24–92 months) 15 of 20 patients (75%) had excellent or good outcomes. A high fusion rate can be expected with reasonable intraoperative or postoperative complications. © 2000 Lippincott Williams & Wilkins, Inc.