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This retrospective study demonstrates the clinical and radiological outcomes of unstable craniocervical junction treated with occipitocervical fusion.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Material and methods<\/jats:title>\n                <jats:p>The mean age of 52 females and 48 males was 56.89\u00a0years. The clinical and radiological outcomes were assessed, including NDI, VAS, ASIA score, imaging, complications and bony fusion in two used constructs: a modern occipital plate\u2013rod\u2013screw system (<jats:italic>n<\/jats:italic>\u2009=\u200959) and previous bilateral contoured titanium reconstruction plates\u2013screws (<jats:italic>n<\/jats:italic>\u2009=\u200941).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Clinically and on imaging, patients presented with neck pain, myelopathy, radiculopathy, vascular symptoms and craniocervical instability. The mean follow-up was 6.47\u00a0years. A solid bony fusion was achieved in 93.81% of the patients. The NDI and the VAS improved significantly from 28.3 and 7.67 at the presentation to 16.2 and 3.47 at the final follow-up. The anterior and posterior atlantodental interval (AADI and PADI), the clivus canal angle (CCA), the occipitoaxial angle (OC2A) and the posterior occipitocervical angle (POCA) improved significantly. Six patients required early revision.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Occipitocervical fusion can yield excellent results regarding clinical improvement and long-term stability with a high fusion rate. Simple reconstruction plates, though more demanding surgically, achieve similar results. Preserving a neutral patient\u2019s position for fixation avoids postoperative dysphagia and may help prevent adjacent segment disease development.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00586-023-07795-1","type":"journal-article","created":{"date-parts":[[2023,6,9]],"date-time":"2023-06-09T06:03:51Z","timestamp":1686290631000},"page":"3511-3521","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Surgical treatment of craniocervical instability: comparison of two constructs regarding clinical and radiological outcomes of 100 patients"],"prefix":"10.1007","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3476-2401","authenticated-orcid":false,"given":"Mohammed Ahmed","family":"Ismail","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heinrich","family":"Boehm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hussein Abou","family":"El Ghait","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Akar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,6,9]]},"reference":[{"issue":"4","key":"7795_CR1","doi-asserted-by":"publisher","first-page":"E2","DOI":"10.3171\/2015.1.FOCUS14807","volume":"38","author":"AJ Lopez","year":"2015","unstructured":"Lopez AJ, Scheer JK, Leibl KE, Smith ZA, Dlouhy BJ, Dahdaleh NS (2015) Anatomy and biomechanics of the craniovertebral junction. 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