I am more than a little nervous about an operation my husband is going to have next week. It's called an occipito-cervical fusion. I saw a picture of the metal plate they will put at the base of his skull. The plate is attached to two curved rods on either side that go down to his spine and lock in with screws. I listened to the explanation calmly for his sake but I gotta tell you, I'm totally freaked. What are the chances this thing is gonna work?
Although this procedure requires a highly trained surgeon and a surgical team that works well together, it can be done with 100% accuracy and excellent results. What you are looking at is a modern posterior fixation for someone (your husband) with an unstable occipito-cervical spine. As you have described it, that's where the skull meets the upper cervical spine (neck).
Preshaped rods and contoured plates have increased the technical difficulty of the surgery. But these devices can be angled specifically to meet each patients needs. And the improvements in design have reduced problems with the plates pulling out or screws backing out.
MRIs are studied to make sure the surgeon knows exactly where the major blood vessels and nerves are located (and to avoid cutting into them). Bone thickness of the skull as well as the vertebrae are taken into consideration in choosing the right type of fixation and finding the best place to secure it (i.e., screw it in).
Careful surgical technique requires a very detailed knowledge of skull and cervical vertebrae anatomy. The surgeon tries to avoid blood loss, prevent blood clots, and minimize damage to the soft tissues. Each surgical step is performed slowly and deliberately with checking and double-checking holes and screws before making the final placement.
With careful preoperative planning, surgeons can anticipate what is needed before attempting an occipito-cervical fusion with fixation devices and bone graft. As mentioned, 100 per cent accuracy in placement of the plates and screws can be achieved. Solid fusion is the final goal with patient safety a high priority throughout the procedure.
Richard J. Bransford, MD, et al. Posterior Fixation of the Upper Cervical Spine: Contemporary Techniques. In Journal of the American Academy of Orthopaedic Surgeons. February 2011. Vol. 19. No.1. Pp. 49-58.
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