The occipitocervical junction is a complex transitional zone between the cranium and the upper spine. It composes two major joints: the atlantooccipital joint, which allows half of the overall flexion-extension motion of the cervical spine and the atlantoaxial joint, which is responsible for the majority of cervical rotation. Bilateral banding, distraction and axial loading are other important features of this region [1, 2]. Degenerative, inflammatory and tumorous lesions can cause instability of these two joints, which may require instrumentation and fusion. Since the majority of cases involve atlantoaxial instability, this chapter focusses on C1/C2 fixation, while the following chapter on basilar invagination also discusses occipitocervical instrumentation in detail.
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