Techniques for spinal osteotomy have evolved over the past 75 years, and although basic Principles remain the same, certain technical advances have occurred. Smith-Petersen et al. (7) were among the first to describe such techniques with their series of posterior lumbar osteotomies in 1945. LaChapelle (2) followed soon thereafter with his description of staged anterior and posterior lumbar osteotomies in 1946. Mason et al. (3) described his osteotomy of the cervical spine in 1953.
Direct anterior odontoid screw fixation is indicated in patients with acute type II and high type III (with a shallow base) odontoid fractures (Fig. 6-1). The rationale for direct anterior fixation is the achievement of immediate fixation in anatomical alignment, stabilizing the atlantoaxial complex while providing the best environment for fracture healing. The construct preserves C1–C2 rotation while providing rigid internal fixation and avoids restrictive bracing and the complications associated with bone grafting techniques.
Occipitocervical fusion may be indicated for multiple disease processes that render the craniocervical junction unstable. Causes include trauma, rheumatoid arthritis, infection, tumor, congenital deformity, and degenerative processes. This junctional area between the mobile cervical spine and the rigid cranium presents fixation challenges and has a high incidence of significant and devastating spinal cord injury. Historically, stabilization of this junction dates back to 1927, when Foerster1 used a fibular strut graft construct.