Occipitocervical fixation using occipital bone hooks and cervical lateral mass screws: analysis of 16 cases

We present a series of 16 patients who underwent occipitocervical fixation with occipital bone hooks used as a substitute for occipital screws for the treatment of occipitocervical instability. In this technique; instrumentation was started following the decompression with insertion of screws into lateral masses. At the occipital level, two symmetrical burr holes were drilled and two occipital bone hooks were inserted into each burr hole with an inverted position with respect to each other. Afterwards, rod-plates were placed and locked on the hooks and screw heads. Bone grafting was also performed to achieve a solid fusion. There were no neurological or vascular complications associated with this technique. No infection-related complications or hematomas were observed. Cerebro-spinal fluid leaks (CSF) occurred when the burr holes were drilled in 4 patients; however, these ceased when the occipital bone hooks were inserted. There were no cases of postoperative CSF fistula or pseudo-meningocele formation. No instrumentation problem was noted in any of the cases during the follow-up period. Relatively long term (average 30.44 months) evaluation of the technique in terms of stability is satisfactory with no neurological, vascular or other major complications. However, further biomechanical studies are needed.