The transoral approach provides direct access to the upper cervical vertebrae and the craniocervical junction (CCJ) pathologies. However, this approach causes additional destruction to the normal anatomical structures and interferes with normal stability of the CCJ, which also warrants occipitocervical (OC) fixation in most of the cases. Different technique of OC fixation has been described previously. In this study, we retrospectively evaluated the clinical results of 6 consecutive patients (male/female: 3/3; mean age:49) with upper cervical and CCJ pathologies (chordoma in 3 patients, pannus formation secondary to rheumatoid arthritis in 2 patients and malpositioned type II dens fracture in 1 patient) who were operated via transoral resection and subsequently underwent rigid posterior OC fixation with cervical laminar hooks and occipital screws (Vertex™ Reconstruction System; Medtronic, Sofamor Danek). The patients were followed up in a mean time of 31 months (range 14-48 mo). Except for one patient, pain relief was achieved in all patients with preoperative complaint of neck pain. In 3 of the 4 patients with preoperative neurological compromise, the neurological status was improved and none of the patients showed neurological detoriation postoperatively. The integrity of the construct was maintained in all the patients for the duration of the follow-up period and there were no instrumentation failure.

In conclusion, transoral decompression of upper cervical spine pathologies necessitates safe and effective stabilization of the CCJ. Rigid OC fixation with sublaminar hooks and occipital screws provided immediate stability of the CCJ with favorable postoperative fusion rates and clinical outcomes.

Keywords: Cervical spine, craniocervical junction, occipitocervical fixation, transoral resection