A NEW FIXATION PLATE FOR OCCIPITOCERVICAL FUSION - INDICATIONS, SURGICAL TECHNIQUE AND FIRST CLINICAL-RESULTS

Indications for occipito-cervical fusion are destruction by tumor, rar e cases of traumatic destruction and local instabilities mainly induce d by rheumatoid arthritis. Some disadvantages of widely used wiring te chniques are complicated occipital fixation techniques and unsufficien t stability in vertical direction, which demands for the additional us e of polymethylmethacrylat or other techniques. We developed a new fix ation plate, which avoids these disadvantages. The plate can be occipi tally anchored with five AO/ASIF small fragment screws and with 0.9 di ameter cerclage wires at the posterior arches of the cervical vertebra . Until now we have treated ten patients by this technique. Nine of th em suffered from rheumatoid arthritis with instability C1-C2 in all ca ses, existing dens upward migration in one case and inflammatoric dest ruction of the dens axis and the atlanto-occipital joints in all other cases. One patient suffered from metastatic destruction of the second cervical vertebra. The surgical technique and indications are present ed in detail. The satisfactory outcome and solid bony fusion in all ca ses and the absence of severe complications encourage us for the conti nued use of this technique for occipito-cervical fusion.