Review and evolution of occipital fixation devices and techniques

Patient outcomes are comparable between modern plate-based and non-plate-based fixation systems, thus selection of technique is determined by surgeon preference, ease of use, and patient-specific anatomical considerations. Increasingly, modular plate-based and eyelet screw systems are gaining popularity due to their adaptability to varying anatomy, with poly-axial condylar and transarticular screws representing bail-out options in cases of suboccipital decompression or prior hardware failure due to the risk this technique poses to neurovascular structures. Future innovation may give rise to 3-D printed personalized implants for cases with complex anatomical or pathological considerations.