How I do it: Condylar screws.

BACKGROUND

Condylar screws have broadened fixation options for Craniocervical Fusion techniques and are used when occipital squama anchorage is inadequate. They may also outperform barplate constructs in patients with connective tissue disorders.

METHODS

The condyles are entirely dissected, sacrificing the Posterior Condylar Emissary Vein. An entry 3 mm lateral to the foramen magnum is created. Hand drilling converges 20° medially, aiming toward the basion under fluoroscopy, under continuous hypoglossal EMG monitoring. A 34-mm lag screw is inserted and confirmed by intraoperative CT.

CONCLUSION

Condylar screws provide reliable fixation and are a useful adjunct to contemporary CCF techniques.