Fig. 2

A 35-year-old man with occipitocervical deformity was treated with posterior occipitocervical fixation and fusion. a–c Occipital screws, C2 bilateral pedicle screws, a C2 spinous process screw, and C3 bilateral lateral mass screws were placed. Preoperative dynamic radiography and computed tomography (CT) reconstruction images show the occipitocervical deformity and instability. d Preoperative magnetic resonance imaging (MRI) shows the occipitocervical deformity and spinal cord compression. e Preoperative CT shows that the C2 spinous process was relatively broad and thick. f Intraoperative image shows the good position of the screws. g Postoperative MRI shows full decompression of the occipitocervical region. h, i Postoperative CT shows that the C2 spinous process screw was placed correctly, achieving successful occipitocervical fixation. j Follow-up lateral-view radiography shows that a good occipitocervical sequence was achieved, with no loosening of the internal fixation