title: Occipitocervical fusion: fix to C2 or C3?
abstract: OBJECTIVE
  The objective of this study was to explore the differences in clinical outcome between short-segment fixation (SSF; occiput-C2) and multi-segment fixation (MSF; occiput-C2, 3).
  
  
  METHODS
  From January 2008 to January 2012, patients who underwent surgery for instability at the occipitocervical junction were included in the study. Two different groups of surgeons using two different management options completed the surgeries. One group performed SSF, whereas the other group performed MSF. A total of 53 patients met the criteria (33 SSF, 20 MSF). Mean follow-up was 33.9 months (range, 12-62 months). Fusion was demonstrated by plain radiographs and computed tomography imaging. Neurological status, pillow neck pain, operative time, blood loss during operation, and perioperative complications were compared between the SSF and MSF groups.
  
  
  RESULTS
  The fusion rate was 97% in the SSF group and 100% in MSF the group. There was no statistically significant difference in the fusion rate between the two groups (P>0.05). One patient (3%) in the SSF group and two patients (10%) in the MSF group experienced perioperative complications. Of the 25 patients who had neurological symptoms, 22 (88%) showed improvement after the operation in the SSF group and 14 (87.5%) of 16 showed improvement in MSF group. In addition, patients who suffered from pillow neck pain achieved varying degrees of improvement after the operation.
  
  
  CONCLUSIONS
  SSF may be the better choice for treating occipitocervical instability when no subaxial instability is present. Overall, modern instrumentation can provide the stability needed for successful clinical fusion.
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
authors.forename: Junwei
authors.initials: J
authors.lastname: Pan
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
authors.forename: Dageng
authors.initials: D
authors.lastname: Huang
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China. Electronic address: haodj2012@126.com.
authors.forename: Dingjun
authors.initials: D
authors.lastname: Hao
authors.affiliation: Department of Public Health, Xi'an Jiaotong University College of Medicine, Shaanxi 710061, China.
authors.forename: Yaling
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
authors.forename: Baorong
authors.initials: B
authors.lastname: He
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
authors.forename: Qining
authors.initials: Q
authors.lastname: Wu
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Spine Surgery, Honghui Hospital, Xi'an Jiaotong University College of Medicine, No. 76 Nanguo Road, 710054 Xi'an, Shaanxi, China.
authors.forename: Chaoyuan
authors.initials: C
authors.lastname: Ge
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016268:Internal Fixators; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery*; D011182:Postoperative Care; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Internal fixation; Occipitocervical fusion; Screw rod/plate; Segment