Abstract
1. Thirteen cases of occipito-cervical fusion performed in the past fifteen years at the London Hospital are described.
2. Seven of the patients had congenital anomalies in the region of the foramen magnum, six had spontaneous atlanto-axial dislocations, and in one case the operation was performed prophylactically to stabilise a severely disorganised cervical spine.
3. Nine of the patients had evidence of neurological involvement before operation due to pressure on the spinal cord or nerve roots.
4. Operative fusion was successful in all cases and there was no operative mortality.
5. The clinical results were good in eight cases and four patients were improved. The condition of one patient, in whom progressive disseminated sclerosis was also present, deteriorated.
6. The technique of operation is described, and it is recommended that it should always be performed as a combined orthopaedic and neurosurgical procedure.
