Cervical spineMinimally invasive surgery

Occipitocervical fusion (occipital to upper cervical spine)

Occipitocervical fusion (occipital to upper cervical spine) is indicated for patients with severe upper-neck and occipital pain, instability or difficulty keeping the head upright, often with neurological symptoms (tingling, weakness, gait issues) from cord compression at the craniocervical junction. The procedure rigidly connects the occipital bone to the upper cervical vertebrae using screws, rods and bone graft to create a stable construct that protects the cord and nerve roots. Indication is personalised, based on symptoms, neurological exam and MRI/CT, especially in complex scenarios such as instability, deformity, trauma or inflammatory disease.

Spine neurosurgeon in Alicante and Benidorm

More than 20 years of experience in Neurosurgery (since 2003)

Vithas Medimar Hospital Alicante and Hospital Clínica Benidorm

Medical illustration of occipitocervical fusion to stabilize the cranio-cervical junction.

What is Occipitocervical fusion?

It is a stabilisation surgery that links the occipital bone to the upper cervical vertebrae (usually C1–C2) with instrumentation and bone graft to prevent unstable motion that could compress the cord or roots. Unlike other cervical fusions, it targets the craniocervical junction, a highly mobile area close to the brainstem.

Symptoms and warning signs

In craniocervical conditions, watch for:

Severe pain in the upper neck and back of the head, worsened by movement

Occipital headaches linked to posture

Feeling of instability or needing to support the head

Walking difficulty, stiff or unsteady gait, tendency to trip

Red flags: loss of strength in arms or legs, frequent falls, bowel or bladder changes, high cord compression or rapid neurological changes

When is this procedure indicated?

Severe, disabling occipitocervical pain despite conservative treatment

MRI/CT showing occipitocervical instability, fractures, malformations or significant cord compression

Neurological progression: worsening strength, coordination or gait, falls, increasing clumsiness

Pain and instability markedly limiting quality of life and work

Severe deformity, dislocation, post-traumatic change or inflammatory disease compromising occipitocervical stability

How is the procedure performed?

1.Preoperative preparation

A thorough neurological exam and detailed review of MRI, CT and dynamic X-rays are performed. Goals, instrumentation, benefits and risks are explained. Fasting instructions and adjustments of anticoagulants/antiplatelets are given, with comorbidities assessed by anaesthesia. Additional studies may be requested in complex anatomy.

2.During the procedure

Under general anaesthesia, the patient is positioned prone with the head secured. A midline occipital–cervical incision exposes the occipital bone and upper cervical vertebrae. Occipital anchors and cervical screws (lateral mass or pedicle) are placed, with decompression (laminectomy) if needed. They are connected with rods, bone graft is added for fusion and the wound is closed in layers with a drain if needed.

3.Immediate postoperative period

After surgery, vitals, neurological status and pain are monitored in recovery and on the ward. Neck and occipital pain is expected and managed with analgesia. Mobilisation starts progressively (sitting, walking with assistance). A cervical collar is often used to protect early fusion. Hospital stay is usually 4–7 days depending on recovery.

Recovery and daily life

Recovery is gradual and requires adapting to reduced neck motion. Early weeks often bring muscle pain, fatigue and limited movement. Return to office work is usually considered between 6 and 8 weeks; physical or high-risk jobs may need 3–6 months or more. Physiotherapy, posture re-education and tailored exercises build strength and balance. Watch for fever, swelling, new weakness, gait or sensory changes and seek prompt review if they occur.

Risks and possible complications

General risks: anaesthesia, infection, bleeding, haematoma, venous thrombosis. Specific risks: spinal cord or root injury with neurological worsening, malposition of screws or anchors requiring revision, pseudoarthrosis, residual or chronic neck pain, loss of neck mobility, adjacent level degeneration and, rarely but importantly, vascular injury or damage near the brainstem. These risks are weighed against leaving severe occipitocervical instability untreated.

Frequently asked questions

It usually lasts between 3 and 5 hours depending on complexity, levels involved and need for decompression. Add time for operating room preparation and recovery. The team will provide an estimate for your case.

There is no pain during surgery due to general anaesthesia. Afterwards, pain in the back of the head, neck and shoulder muscles is common, managed with analgesia and decreasing over days. Pain from instability or compression often improves gradually.

For office-based jobs, return is usually considered between 6 and 8 weeks depending on pain, balance and comfort. Physical or high-risk jobs may need 3–6 months or more, adjusted in follow-up.

Gentle walking starts early and increases progressively. Impact or contact sports and activities needing wide neck motion are usually postponed several months, often from 3–6 months, following surgical and rehab guidance.

The fusion aims to permanently stabilise the treated region, so recurrence of the same instability is unlikely there. Other segments may degenerate over time, and if preoperative neurological damage was significant, recovery may be partial.

Limited cervical fusions fix cervical levels without including the occiput. Occipitocervical fusion targets the craniocervical junction, more complex and mobile, reserved for instability, deformity or compression in that area. It involves greater loss of motion, which is discussed beforehand.

Do these symptoms sound familiar?

If you recognise yourself in some of these symptoms and your pain is starting to limit your daily life, we can review your case in a personalised consultation. Dr. Ben Ghezala will assess your clinical history and imaging studies to help you decide the best treatment option for you.

Request a consultation with Dr. Ben Ghezala