title: Densitometric comparison of 3 occipital regions for suitability of fixation.
abstract: OBJECTIVE
  Atlantooccipital fixation is an important technique in the treatment of upper cervical spine instability. Important considerations for implant devices are obtrusiveness and propagation of torque through the device caused by cervical rotation. The authors evaluated the feasibility of 3 regions of the occiput as sites for occipitocervical fixation by examining bone mineral density at these locations.
  
  
  METHODS
  Unembalmed occiputs of 9 male and 4 female cadavers were used (mean age at time of death was 61.6 years, range 36-68 years). Studies were undertaken using caliper measurements and dual-energy x-ray absorptiometry of the superior nuchal line (SNL), the external occipital protuberance (EOP), and the inferior nuchal line (INL).
  
  
  RESULTS
  Data indicate that the bone at the INL has a similar volumetric bone density as the bone at the SNL, despite having half the thickness. Also, the volumetric bone density increases laterally along the nuchal lines.
  
  
  CONCLUSIONS
  Most hardware fixation is centered on stabilization at the EOP and the SNL. On the basis of these radiological results, the INL shows promise as a potential alternative site for screw placement in occipitocervical fixation.
authors.affiliation: Division of Neurological Surgery, University of Toledo Medical Center, Toledo, Ohio; and.|Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Chandan
authors.initials: C
authors.lastname: Das
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Anna G U S
authors.initials: AG
authors.lastname: Newcomb
authors.affiliation: Division of Neurological Surgery, University of Toledo Medical Center, Toledo, Ohio; and.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Gaudin
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
authors.forename: Neil R
authors.initials: NR
authors.lastname: Crawford
mesh_terms: D000328:Adult; D000368:Aged; D001269:Atlanto-Occipital Joint / Q000601:surgery*; D001860:Bone Plates; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D016267:External Fixators; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery*; D009778:Occipital Lobe / Q000601:surgery; D013123:Spinal Fusion / Q000379:methods; D016896:Treatment Outcome
keywords: EOP = external occipital protuberance; INL = inferior nuchal line; SNL = superior nuchal line; atlantooccipital fixation; bone density; cervical; superior nuchal line; vBMD = volumetric bone mineral density