Occipitocervical fusion: fix to C2 or C3?

Objective: The objective of this study was to explore the differences in clinical outcome between short-segment fixation (SSF; occiput-C2) and multi-segment fixation (MSF; occiput-C2, 3).

Methods: From January 2008 to January 2012, patients who underwent surgery for instability at the occipitocervical junction were included in the study. Two different groups of surgeons using two different management options completed the surgeries. One group performed SSF, whereas the other group performed MSF. A total of 53 patients met the criteria (33 SSF, 20 MSF). Mean follow-up was 33.9 months (range, 12-62 months). Fusion was demonstrated by plain radiographs and computed tomography imaging. Neurological status, pillow neck pain, operative time, blood loss during operation, and perioperative complications were compared between the SSF and MSF groups.

Results: The fusion rate was 97% in the SSF group and 100% in MSF the group. There was no statistically significant difference in the fusion rate between the two groups (P>0.05). One patient (3%) in the SSF group and two patients (10%) in the MSF group experienced perioperative complications. Of the 25 patients who had neurological symptoms, 22 (88%) showed improvement after the operation in the SSF group and 14 (87.5%) of 16 showed improvement in MSF group. In addition, patients who suffered from pillow neck pain achieved varying degrees of improvement after the operation.

Conclusion: SSF may be the better choice for treating occipitocervical instability when no subaxial instability is present. Overall, modern instrumentation can provide the stability needed for successful clinical fusion.