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Craniovertebral Junction Fusion
Lubdha M. Shah, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • O-C1 fusion, craniovertebral junction (CVJ) fusion
          • Synonyms

            • Occipitocervical (OC) instrumentation, craniocervical fusion, craniovertebral fusion, atlantoaxial arthrodesis
          • Definitions

            • Various reasons for fusion of CVJ: Rheumatoid arthritis(RA), Down syndrome, trauma, mucopolysaccharidoses, neoplasm, congenital abnormalities, inflammatory arthropathy, infection
            • Plate fixation to occiput in situations where posterior elements of upper cervical spine have been excised or are incompetent
            • Adequate decompression of CVJ & solid bony fusion to prevent further neurologic deterioration

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Imaging Recommendations

                    PATHOLOGY

                    • General Features

                      • Staging, Grading, & Classification

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                Selected References

                                1. Mouchaty H et al: Craniovertebral junction lesions: our experience with the transoral surgical approach. Eur Spine J. 18 Suppl 1:13-9, 2009
                                2. Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
                                3. Finn MA et al: Surgical treatment of occipitocervical instability. Neurosurgery. 63(5):961-8; discussion 968-9, 2008
                                4. Shahlaie K et al: Occipitocervical fusion using recombinant human bone morphogenetic protein-2: adverse effects due to tissue swelling and seroma. Spine (Phila Pa 1976). 33(21):2361-6, 2008
                                5. Nockels RP et al: Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine. 7(2):117-23, 2007
                                6. Deutsch H et al: Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 30(5):530-5, 2005
                                7. Sandhu FA et al: Occipitocervical fusion for rheumatoid arthritis using the inside-outside stabilization technique. Spine (Phila Pa 1976). 28(4):414-9, 2003
                                8. Visocchi M et al: Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience. Acta Neurochir (Wien). 145(4):265-72; discussion 272, 2003
                                9. McCullen GM et al: Spine update: cervical spine internal fixation using screw and screw-plate constructs. Spine (Phila Pa 1976). 25(5):643-52, 2000
                                10. Haher TR et al: Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976). 24(1):5-9, 1999
                                11. Grob D et al: Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine (Phila Pa 1976). 22(14):1580-3; discussion 1584, 1997
                                12. Ebraheim NA et al: An anatomic study of the thickness of the occipital bone. Implications for occipitocervical instrumentation. Spine (Phila Pa 1976). 21(15):1725-9; discussion 1729-30, 1996
                                Related Anatomy
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                                Related Differential Diagnoses
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                                References
                                Tables

                                Tables

                                KEY FACTS

                                • Terminology

                                  • Imaging

                                    • Pathology

                                      • Clinical Issues

                                        TERMINOLOGY

                                        • Abbreviations

                                          • O-C1 fusion, craniovertebral junction (CVJ) fusion
                                        • Synonyms

                                          • Occipitocervical (OC) instrumentation, craniocervical fusion, craniovertebral fusion, atlantoaxial arthrodesis
                                        • Definitions

                                          • Various reasons for fusion of CVJ: Rheumatoid arthritis(RA), Down syndrome, trauma, mucopolysaccharidoses, neoplasm, congenital abnormalities, inflammatory arthropathy, infection
                                          • Plate fixation to occiput in situations where posterior elements of upper cervical spine have been excised or are incompetent
                                          • Adequate decompression of CVJ & solid bony fusion to prevent further neurologic deterioration

                                        IMAGING

                                        • General Features

                                          • Radiographic Findings

                                            • CT Findings

                                              • MR Findings

                                                • Imaging Recommendations

                                                  PATHOLOGY

                                                  • General Features

                                                    • Staging, Grading, & Classification

                                                      CLINICAL ISSUES

                                                      • Presentation

                                                        • Demographics

                                                          • Natural History & Prognosis

                                                            • Treatment

                                                              Selected References

                                                              1. Mouchaty H et al: Craniovertebral junction lesions: our experience with the transoral surgical approach. Eur Spine J. 18 Suppl 1:13-9, 2009
                                                              2. Ahmed R et al: Fusions at the craniovertebral junction. Childs Nerv Syst. 24(10):1209-24, 2008
                                                              3. Finn MA et al: Surgical treatment of occipitocervical instability. Neurosurgery. 63(5):961-8; discussion 968-9, 2008
                                                              4. Shahlaie K et al: Occipitocervical fusion using recombinant human bone morphogenetic protein-2: adverse effects due to tissue swelling and seroma. Spine (Phila Pa 1976). 33(21):2361-6, 2008
                                                              5. Nockels RP et al: Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine. 7(2):117-23, 2007
                                                              6. Deutsch H et al: Occipitocervical fixation: long-term results. Spine (Phila Pa 1976). 30(5):530-5, 2005
                                                              7. Sandhu FA et al: Occipitocervical fusion for rheumatoid arthritis using the inside-outside stabilization technique. Spine (Phila Pa 1976). 28(4):414-9, 2003
                                                              8. Visocchi M et al: Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience. Acta Neurochir (Wien). 145(4):265-72; discussion 272, 2003
                                                              9. McCullen GM et al: Spine update: cervical spine internal fixation using screw and screw-plate constructs. Spine (Phila Pa 1976). 25(5):643-52, 2000
                                                              10. Haher TR et al: Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976). 24(1):5-9, 1999
                                                              11. Grob D et al: Atlantoaxial fusion and retrodental pannus in rheumatoid arthritis. Spine (Phila Pa 1976). 22(14):1580-3; discussion 1584, 1997
                                                              12. Ebraheim NA et al: An anatomic study of the thickness of the occipital bone. Implications for occipitocervical instrumentation. Spine (Phila Pa 1976). 21(15):1725-9; discussion 1729-30, 1996