Occipitocervical fixation using hooks and screws for upper cervical instability

OBJECTIVES: Occipitocervical fixation is used for the treatment of nontraum atic upper cervical instabilities. To date, plates have been fixed with scr ews or wires. However, these devices are not indicated in the treatment of patients with severe osteoporosis or in instances of significant thinning o f the occipital bone. We performed a clinical trial of a new type of fixati on that uses cervical interlaminar hooks and occipital claws with hooks or with screws (CCD type; Sofamor-Danek, Roissy, France) for the treatment of nontraumatic upper cervical instabilities. METHODS: Five women and one man ranging in age from 28 to 72 years (average age, 54 yr) were thus treated. The CCD type material had two rod plates an d hooks allowing the proper placement of interlaminar and occipital claws. The occipital plate can also be directly screwed to the bone. Occipital hoo ks were used in four patients. The other two patients, who had occipitocerv ical congenital abnormalities that required an occipitocervical opening and an additional dural enlargement, underwent occipital screw fixation becaus e of the previous opening of the foramen magnum. A cancellous iliac autogra ft allowed the usual fusion. RESULTS: No postoperative complications were observed, and all patients exp erienced significant improvement of their neck pain. Four patients had neur ological symptoms. The condition of two patients improved, and the conditio n of the other two stabilized. CONCLUSION: This report confirms the interest of the CCD method to correct all types of upper cervical instabilities, even in cases of unusual thinnin g of the occipital bone or in osteoporotic states.