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Occipito-Cervical Fusion Surgery

What does the word “Occipital-Cervical Fixation” mean?

  1. Occipital: back of the skull (occiput)
  2. Cervical: part of the spine located in the neck
  3. Fixation: to connect two structures together

Altogether, “Occipital-Cervical Fixation” means connecting the skull to the back of the neck to provide stability.

What is an Occipital-Cervical Fixation?

An occipital-cervical fixation is a spine surgery which connects the skull to the neck (cervical spine).

Why is an Occipital-Cervical Fixation done?

This surgery is done due to instability of the upper part of the neck. The patient can no longer control and protect this part of the spine. The fear is that this part of the spine could fall forward and injure the spinal cord. Often the spinal cord is already under compression. For that reason, the skull and cervical spine are connected to provide stability.

In some instances this surgery is done after bone is removed from the back of the highest neck vertebrae. In this case, the neck bones are no longer stable enough after surgery to support the spine.

How is an Occipital-Cervical Fusion Surgery done?

  1. An intravenous catheter (IV) is started and antibiotics are given before surgery.
  2. This surgery is done in an Operating Room.
  3. The patient is initially place on the back (supine) and a General Anesthetic given.
  4. The patient is then carefully rolled onto their stomach (prone).
  5. The head and neck are carefully positioned for the surgery.
  6. The back of the head and neck are cleaned with a surgical antiseptic and plastic covers (drapes) are placed around the surgical area.
  7. The surgeon makes a cut into the skin which goes from the back of the head downward over the spine.
  8. The tissue under the skin (subcutaneous tissue, fat, fascia) are divided with a cautery.
  9. After placing retractors (metal devices used to see the anatomy below), the back of the skull and spine are seen.
  10. The muscles of the spine are separated from the spine bones and pushed to the side with retractors.
  11. Many X-Rays are taken throughout the surgery, especially when placing any metal devices into the skull or spine.
  12. A small titanium plate is attached to the middle of the back of the skull, where the skull bone is the thickest. Small screws are used to attach it firmly.
  13. If the patient has compression of the spinal cord at one or more of the spinal levels targeted, the spinous process and lamina bone are removed from these segments. The spinal cord can then be freed up from any compression.
  14. Small titanium screws are place into the outer, thicker part of the cervical vertebrae (lateral mass). These screws are then connected to the plate on the skull with two rods. This makes a rigid connection between the skull and the spine.
  15. The bone around the screws and rods is then prepared for a fusion.
  16. Small pieces of bone from the patient or other materials are then placed in the area.
  17.  The main part of the surgery is now complete.
  18. The neck muscles are stitched (sutured) back together.
  19. The scalp and skin over the spine are stitched (sutured) back together.
  20. Bandages (dressings) are placed over the wound.
  21. A firm brace is placed over the neck.
  22. The patient is then carefully rolled on their back (supine) and awoken from Anesthesia.
  23. The patient is then brought to the Recovery Room where more X-Rays are typically taken.

How long does surgery like this typically take?

This surgery can take anywhere from 4-8 hours or more, depending on many factors.

This is a complex surgery with many variables and challenges.

What is the recovery from an Occipital-Cervical Fixation like?

1. Patients who undergo an Occipital-Cervical Fixation are admitted to the hospital for at least 3-5 days, often more.

2. The recovery time is usually 8-12 weeks or more.

3. A firm neck brace is usually recommended. The use of braces and the length of wearing one, depends on the surgeon’s preference.

4. The movement in your neck is typically restricted. For instance, the surgeon may ask you not to try to look up or down for a period of time.

5. The surgeon will restrict the amount of weight you can lift. This is done to avoid too much stress on the area of the surgery.

6. You may be asked to avoid taking anti-inflammatory medication (NSAIDS), as they can interfere with the fusion.

7. You may be asked not to smoke or be around Tabaco smoke for a period of time as nicotine interferes with fusions.

7. The surgical wound will typically take 4-8 weeks to heal completely.

8. The surgeon will typically take another X-Ray in days to weeks after surgery to make sure the bone graft and metal plates and screws are in a good position. This will be repeated at certain intervals to see how the fusion is coming along.

9. Sometimes Physical Therapy (PT) can be used to help with the neck mobility once the spine has healed.

10. It may take 6 months to 1 year for a bone fusion to be solid. This does not mean that a patient would have pain or be very restricted in their movement during this time.

11. The symptoms (pain, numbness, weakness) from the spinal cord compression can take weeks to months to reach the maximum level of improvement. In cases where the spinal cord was compressed for a long period of time, some of the symptoms may remain.

What type of benefit can patients gain from an Occipital-Cervical Fixation surgery?

The main benefit to the patient is the stability the surgery creates for the neck and head. Also, the spinal cord is not protected preventing further injury.

The recovery of symptoms from spinal cord compression following this surgery can vary depending on the severity length of the compression before surgery. A complete or partial recovery is possible.