Figure 2

Figure 2

Occipital cervical fusion requires fixation to the occiput C1 C2 and frequently C3

Three-bones-of-the-occipital-cervical-junction--occiput--C1--and-C2--join-together-to-form-a-single--complex--highly-mobile-articulation----The-structural-ligaments-of-this-joint-complex-span-from-the-occiput-to-C2-with-C1-acting-as-a-spacer-or-a-cushion----The-convex-surfaces-of-the-occipital-condyles-join-matching-concave-surfaces-on-the-cephalad-portion-of-C1----This-joint-provides-half-of-the-overall-cervical-flexion-/-extension-motion-(45-degrees)----The-transverse-ligament-attaches-to-the-anterior-arch-of-C1-on-both-sides-and-wraps-around-the-odontoid-process-of-C2----The-flat-articulating-surfaces-between-the-lateral-joints-of-C1-and-C2-provide-rotation-along-the-axis-of-the-odontoid-process----This-joint-provides-half-of-the-normal-rotation-of-the-cervical-spine-(45-degrees-to-each-side)----The-principal-ligaments-joining-these-three-bones-together-are-the-two-alar-ligaments-extending-from-the-base-of-the-occipital-condyles-to-the-lateral-top-surfaces-of-the-odontoid-process-and-the-central-apical-ligament----Additional-secondary-restraints-include-the-cephalad-portion-of-the-anterior-longitudinal-ligament-(anterior-atlanto-occipital-ligament)-cephalad-extension-of-the-posterior-longitudinal-ligament-(tectorial-membrane)--and-cephalad-extension-of-the-ligamentum-flavum-(posterior-atlanto-occipital-membrane)--

Occipital cervical fusion requires fixation to the occiput, C1, C2, and frequently C3. Fixation to the occiput is obtained by screws. Fixation to C1 is usually obtained through sublaminar wires across the posterior arch of C1. Fixation into C2 can be achieved through pedicle screws in C2 or screws extending from the pedicle of C2 into the lateral mass of C1 across the C1 C2 joint. Fixation to C3 is achieved through screws in the lateral mass of C3. Older fusion techniques involved passing wires through the occipital bone, C1 and C2 arches, spinous processes at C2 C3 or lateral masses of C2 and C3. 

Level:

Structures:

 

Other Structures:

Pathology:

Procedure:

View:

Entire occipitocervical junction

Neural: Brainstem and spinal cord

Dura

None

Normal

Plate and screws in occiput, C2, C3

Composite (3/4), Front, Lateral, Caudal