Percutaneous anterior occiput-to-axis screw fixation: technique aspects and case series

Abstract Background context Posterior occipitocervical fusion techniques have been previously described; however, traditional open anterior approaches are plagued by exposure difficulty. A minimally invasive percutaneous anterior occipitocervical fixation approach avoids this difficult exposure procedure. Purpose This article describes a novel technique of percutaneous anterior occiput-to-axis screw fixation and its clinical outcomes. Study design Technique report. Methods Anteroposterior, lateral and open-mouth views, and computed tomography scans are preoperatively obtained to appraise the feasibility of surgery. We extend our experience of using percutaneous anterior transarticular screw fixation to occiput-to-axis screw fixation. This procedure was performed on six patients. Results The operation was successfully performed on all patients without technical difficulties, and no vertebral artery, nerve injury or soft tissue (such as esophageal) complications occurred. All six patients followed up 10 to 39 months (averaged 20.5 months). Bone union was achieved in five patients, and the one patient lacking bone union was stable at final follow-up. The syringomyelia of four patients is almost complete reduction. No screw loosening or breakage has occurred. Conclusions With the correct puncture point, angle of insertion, and use of the appropriate tools, we suggest that percutaneous anterior occiput-to-axis fixation technique is a feasible, safe, and minimally invasive procedure.