Ashafai Nabeel S, Visocchi Massimiliano, Wąsik Norbert
Alshafai Neurosurgical Academy (ANA), Toronto, ON, Canada.
Institute of Neurosurgery Catholic University of Rome, Rome, Italy.
Acta Neurochir Suppl. 2019;125:247-252. doi: 10.1007/978-3-319-62515-7_35.
Occipitocervical fusion (OCF) is indicated for instability at the craniocervical junction (CCJ). Numerous surgical techniques, which evolved over 90 years, as well as unique anatomic and kinematic relationships of this region present a challenge to the neurosurgeon. The current standard involves internal rigid fixation by polyaxial screws in cervical spine, contoured rods and occipital plate. Such approach precludes the need of postoperative external stabilization, lesser number of involved spinal segments, and provides 95-100% fusion rates. New surgical techniques such as occipital condyle screw or transarticular occipito-condylar screws address limitations of occipital fixation such as variable lateral occipital bone thickness and dural sinus anatomy. As the C0-C1-C2 complex is the most mobile portion of the cervical spine (40% of flexion-extension, 60% of rotation and 10% of lateral bending) stabilization leads to substantial reduction of neck movements. Preoperative assessment of vertebral artery anatomical variations and feasibility of screw insertion as well as visualization with intraoperative fluoroscopy are necessary. Placement of structural and supplemental bone graft around the decorticated bony elements is an essential step of every OCF procedure as the ultimate goal of stabilization with implants is to provide immobilization until bony fusion can develop.
枕颈融合术（OCF）适用于颅颈交界区（CCJ）的不稳定。90多年来发展起来的众多手术技术，以及该区域独特的解剖和运动关系，给神经外科医生带来了挑战。目前的标准方法包括在颈椎使用多轴螺钉进行内固定、塑形棒和枕骨板。这种方法无需术后外部固定，涉及的脊柱节段较少，融合率达95% - 100%。新的手术技术，如枕髁螺钉或经关节枕髁螺钉，解决了枕骨固定的局限性，如枕骨外侧厚度变化和硬脑膜窦解剖结构问题。由于C0 - C1 - C2复合体是颈椎最活动的部分（屈伸占40%，旋转占60%，侧弯占10%），稳定该区域会导致颈部活动大幅减少。术前评估椎动脉解剖变异和螺钉置入的可行性以及术中透视显像是必要的。在去皮质骨元件周围放置结构性和补充性骨移植是每个OCF手术的关键步骤，因为植入物稳定的最终目标是提供固定，直至骨融合形成。
