Free-hand placement of occipital condyle screws: a cadaveric study

El-Gaidi MA, Eissa EM, El-Shaarawy EAA. "Free-hand placement of occipital condyle screws: a cadaveric study." European Spine Journal. 2014;23:2182-2188. copy at


Purpose: Cranio-vertebral junction fixation is challenging due to the complex topographical anatomy and the presence of important anatomical structures. There are several limitations to the traditional occipital squama fixation methods. The purpose of this work is to assess the safety and feasibility of a new optimum trajectory of occipital condyle (OC) screws for occipitocervical fixation via a free-hand technique.
Methods: Eight different parameters of OC morphology were studied in fifty adult skulls. Free-hand placement of OC screws was performed in five cadavers using 3.5-mm titanium polyaxial screws and a 3-mm rod construct (C0–C1–C2). Postoperative computed tomography was performed to determine the success of the screw placement and their angulation, length and effect on hypoglossal canal volume.
Results: The average length, width and height of the OC were 24.2 ± 3.6, 14.2 ± 1.9, and 10.7 ± 2 mm, respectively. The average medio-lateral, hypoglossal canal and atlanto-occipital joint angles were 38.8_ medially ±5_, 7.4_ rostrally ±1.9_ and 23.4_ caudally ±3.5_, respectively. The
ten screws were successfully inserted using a free-hand technique with bicortical purchase. There was no vertebral artery injury or breach of the hypoglossal canal in any specimen. The average screw length was 22.2 ± 3.9 mm. The average medio-lateral angle was 30_ medially ±6.7_. The average cranio-caudal angle was 4_ caudally ±6.2_.
Conclusions: The free-hand technique of OC screw placement is a safe and viable option for occipitocervical fixation and may be a preferred alternative in selected cases. However, further studies are needed to compare its safety and reliability to other more established methods.