1459. A Novel Technique for Occipito-Cervical Fixation After Extensive Suboccipital Craniectomy

Authors: Carlos Goulart, MD; Shawn Rai, MD; Ziya Gokaslan; Michael Galgano, MD (Syracuse, NY)

Introduction:

Occipitocervical (OC) instability can lead to life-threatening complications as a result from trauma, extensive posterior fossa decompression, genetic disorders, infections, tumors and congenital malformations. In rare cases the occipital bone quality or absence of impairs the ability to perform appropriate fusion using traditional techniques. Cervical rod-integrated plate, transarticular occipitoatlantal screw fixation and occipital condyle screws have been studied as alternatives in these challenging situations.

Methods:

We describe a new technique for OC fusion after extensive suboccipital craniectomy illustrated by a trauma case of a 32-year-old male who presented with OC dislocation after a fall from 30 feet. The patient was a GCS of 11T upon arrival, moving all extremities to command. The patient was placed in a halo vest prior to OC fusion surgery. In the operating room, all neuromonitoring signals were lost prior to any positioning, and his neurological exam abruptly declined. Emergent imaging showed new tonsillar descent and severe posterior fossa swelling. The patient required emergent extensive decompressive suboccipital craniectomy. To avoid a second operation, we decided to perform the OC fusion at the same time, but a standard plate-rod construct was not feasible given the extensive bony defect. Therefore, we performed the fixation by placing two inion screws 4.5 x 12mm, that were connected through two articulating rods with the C1-4 screws. In addition, a sublaminary wire was passed through a hole drilled through the midline of the inion and was connected to a cross rod at the level of C4.

Results:

Follow-up imaging revealed a stable construct from the inion to C4.

Conclusion:

This is the first description in the literature of inion screw placement to achieve OC fusion which seems to be a valid and safe alternative to traditional OC fusion constructs in cases of patients with extensive suboccipital craniectomy.