E-Mail karger@karger.com Review Pediatr Neurosurg 2018;53:81–88 DOI: 10.1159/000485924 Postoperative Immobilization following Occipitocervical Fusion in the Pediatric Population: Outcome Evaluation and Review of Literature Alexandre R. Pingarilho c Paulo M. Porto de Melo c Samer K. Elbabaa a, b a Division of Pediatric Neurosurgery, Department of Neurological Surgery, Saint Louis University School of Medicine, Saint Louis, MO, and b Pediatric Neurosurgery, Pediatric Neuroscience Center of Excellence, Arnold Palmer Hospital for Children, Orlando, FL, USA; c Departamento de Neurocirurgia. Hospital Militar de Área de São Paulo – HMASP, Exército Brasileiro, São Paulo, Brazil The different methods of postoperative immobilization did not affect outcomes. Then, we can conclude that screw-and- rod constructions in occipitocervical fusion augment the rates of fusion, independently from which immobilization was used, even when none was used at all. © 2018 S. Karger AG, Basel Introduction The occipitocervical junction comprises 2 important joints for head and neck movements and stability: the at- lanto-occipital and atlantoaxial joints. The involved bones include the occipital bone (O), atlas (C 1 ) and axis (C 2 ). This region is considered as the site of a wide variety of pathologies. They can be divided into congenital, de- velopmental, and acquired. In this context, traumatic/ posttraumatic, congenital, and inflammatory conditions (rheumatoid arthritis), neoplasms, and infections (Grisel syndrome) stand out. Any of these, if not treated, can lead to severe neurological impairments. Congenital abnormalities are common to find at birth and in early childhood. Most of them are syndromes, Keywords Occipitocervical fusion · Children · Postoperative immobilization · Literature review Abstract The scientific literature does not have a consensus about the role and method of postoperative immobilization after oc- cipitocervical fusion in the pediatric population. The primary goal of this study is to review the medical literature and eval- uate different immobilization methods and their impact on fusion, following the surgical management of craniocervical instability in children. It started with an extensive research of randomized controlled trials, series of cases and case re- ports, describing occipitocervical junction pathologies, clin- ical, epidemiological characteristics, and treatment. The search was performed using the Pubmed database evaluat- ing all the literature involving postoperative immobilization after occipitocervical fusion in pediatric patients. The results showed that most cases of occipitocervical stabilization were due to congenital spinal instability followed by trauma in most series. The most common type of surgery performed was occipitocervical fusion using screw and rod constructs. Received: October 17, 2017 Accepted: November 29, 2017 Published online: January 20, 2018 Alexandre R. Pingarilho 261, Mairinque Street, ap. 42 São Paulo, SP 04037-020 (Brazil) E-Mail alexandrepingarilho @ gmail.com © 2018 S. Karger AG, Basel www.karger.com/pne