Occipital-cervical fusion using the Locksley intersegmental tie bar technique: Long-term experience with 19 patients

Background context: The management of lesions at the craniocervical junction presents unique difficulties for the spine surgeon. The complexity of this region creates a variety of mechanical forces that challenge any fusion construct. An understanding of the ligamentous, bone and vascular structures in this region is critical. Purpose: To describe a method of occipital-cervical fusion with long-term follow-up. Study design/setting: Retrospective case series. Patient sample: Twenty-one consecutive patients with craniocervical compression and/or instability who were treated using the Locksley intersegmental tie bar technique. Outcome measures: Neurologic function, fusion, postoperative complications. Methods: Patients with craniocervical instability underwent occipital-cervical fusion using the Locksley intersegmental tie bar technique. The pathologic processes causing compression and/or instability at the craniocervical junction, as well as the patients' pre- and postoperative neurologic status, are reported. Results: Solid fusion was attained in all 19 patients surviving at 2 years. Two patient deaths were reported in this series in the early postoperative period because of systemic disease. Conclusions: This approach allows for rigid, immediate stabilization of this region. An external orthosis is most often not required. This technique has unique applicability to patients where the normal ligamentous and bone structures are weakened because of underlying disease or injury.