Inside-outside technique for posterior occipitocervical spine instrumentation and stabilization: preliminary results

Object. The authors present a series of 16 patients who underwent inside-ou tside occipital and posterior cervical spine stabilization. Methods. In this technique, the screw was placed from the inside of the occ iput to the outside. An articular (lateral) mass plate was contoured to the shape of the occipital bone and the cervical spine and affixed to the occi put with a flat-headed screw or stud placed through a burr hole in the calv aria with the flat head of the screw in the epidural space and the threads facing outward. The bone plate was then secured with a nut to the occipital screw and the cervical plate was attached to the spine with a bone screw t hat coursed through the plate and into the articular pillar. Our series inc luded six children and 10 adults. In five patients, previous fusion had fai led; in two patients spinal instability was secondary to Down's syndrome; t wo patients' instability was related to developmental anomalies; and in fiv e patients spinal instability was due to the presence of tumor. One patient with rheumatoid arthritis had undergone a transoral procedure. Two patient s had suffered traumatic fracture. Three patients died of causes unrelated to the procedure, one patient died of metastatic cancer, and one patient di ed in a long term care facility of cardiopulmonary complications. One patie nt with renal failure suffered a hemorrhage from an arteriovenous fistula a fter being treated with dialysis. In one child, a nut backed off after 3 mo nths. The nut was reseated, and a maturing arthrodesis was present. Conclusions. The authors conclude that the inside-outside occipitocervical fixation is an effective technique for stabilizing the cervical spine.