title: A new technique for intraoperative reduction of occipitocervical instability.
abstract: BACKGROUND
  Occipitocervical instability with vertical migration of the odontoid is a rare but potentially debilitating anomaly of the craniocervical junction. Anterior decompression by means of a transoral or transcervical approach followed by posterior instrumentation commonly is used to treat this pathology.
  
  
  OBJECTIVE
  To develop an innovative operative technique to correct reducible occipitocervical instability using a purely posterior approach.
  
  
  METHODS
  Two patients presented to our institution with occipitocervical instability. One patient developed vertical migration of the odontoid secondary to a retropharyngeal abscess after radiation treatment. The second patient developed occipitocervical instability as a result of pathological destruction of C2 from a breast metastasis. Both patients were myelopathic with severe neck pain.
  
  
  METHODS
  Both patients were brought to the operating room for intraoperative reduction and fixation using a purely posterior approach. This new technique obviated the need for an anterior decompression procedure or preoperative halo reduction. Postoperatively, both patients had excellent restoration of spinal alignment as well as improvement in both pain and myelopathy.
  
  
  CONCLUSIONS
  We achieved intraoperative reduction of occipitocervical instability through a purely posterior approach. This technique adds a tool to the armamentarium of techniques used for the treatment of occipitocervical instability.
authors.affiliation: Department of Neurosurgery, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA. weshsu@jhmi.edu
authors.forename: Wesley
authors.initials: W
authors.lastname: Hsu
authors.forename: Hasan A
authors.initials: HA
authors.lastname: Zaidi
authors.forename: Ian
authors.initials: I
authors.lastname: Suk
authors.forename: Ziya L
authors.initials: ZL
authors.lastname: Gokaslan
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Wolinsky
mesh_terms: D000368:Aged; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001943:Breast Neoplasms / Q000473:pathology; D002277:Carcinoma / Q000150:complications / Q000556:secondary; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008297:Male; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011832:Radiation Injuries / Q000150:complications / Q000473:pathology; D011859:Radiography; D017703:Retropharyngeal Abscess / Q000150:complications / Q000473:pathology; D013117:Spinal Cord Compression / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D013125:Spinal Neoplasms / Q000150:complications / Q000556:secondary