Occipital Cervical Fixation System Set – Posterior Craniocervical Plate-Rod Instrumentation

The Occipital Cervical Fixation System Set from Peak Surgicals (PS1705 series) is a 32-piece posterior craniocervical instrumentation set in stainless steel, designed for the complete intraoperative workflow of occipital-cervical (occiput-to-cervical spine) plate-and-rod posterior fixation — covering occipital bone screw preparation with pointed and flat awls, drill bits in 2.4mm and 2.7mm, and taps in Ø3.5mm and Ø4.0mm; posterior cervical screw insertion with a dedicated screwdriver; marker pin placement and anatomical position marking; rod contouring with two Rod Benders and a Rod Template; rod-to-screw seating with Rod Pusher (open and close variants), Rod Holder, Rod Rocker, Gripper, and Persuader; segmental compression and distraction with a Compressor and Distractor; rod trimming with a Rod Cutter; and final construct locking with an Inner Holder, Inner Tightener, and Screw Holder with Lock, all in an aluminium tray. It is used by spine surgeons and neurosurgeons in hospital operating theatres performing posterior occipital-cervical fixation for craniocervical instability from trauma, rheumatoid arthritis, congenital anomalies, tumour, or infection involving the occiput, atlas (C1), and axis (C2) and the subaxial cervical spine.

Occipital-Cervical Fixation: Anatomy, Indications, and Construct Architecture

The occiput-C1-C2 complex — also called the craniocervical junction — is a structurally unique region of the spine that provides approximately 50% of total cervical flexion-extension (primarily at the occiput-C1 articulation) and approximately 50% of total cervical rotation (primarily at the C1-C2 articulation), while also serving as the transition between the rigid skull and the mobile cervical spine. Instability at the craniocervical junction — from traumatic occipital condyle fractures, atlantoaxial instability, os odontoideum, cranial settling from rheumatoid pannus erosion of the C1-C2 articulations, basilar invagination, Chiari malformation with craniovertebral junction instability, tumour or infection destroying the bony ring of C1 or the dens, or failed prior posterior C1-C2 fixation — requires posterior fusion extending from the occiput to the stable subaxial cervical spine below, spanning the unstable craniocervical segment with an occipital plate connected by rods to lateral mass or pedicle screws in the cervical vertebrae below C2. The PS1705 Occipital Cervical Fixation System Set provides the complete instrument set for occipital plate screw placement, posterior cervical lateral mass screw insertion, rod contouring, rod seating, segmental compression and distraction, and final construct locking at every level from the occiput to the subaxial cervical spine.

Occipital Bone Screw Preparation: Awls, Drill Bits, Taps, and Depth Gauge

Occipital bone screw insertion requires careful preparation to avoid penetrating the inner cortex of the occipital bone and entering the posterior cranial fossa — the dura mater and the transverse sinuses are immediately deep to the inner cortical table of the occipital bone in the paramedian region where occipital screws are placed. The Awl Pointed (PS1705.036) perforates the outer cortex of the occipital bone at the chosen screw position, guided by fluoroscopy and manual tactile feedback. The Awl Flat (PS1705.041) is used for a wider cortical opening when the outer cortical table requires a blunt entry before drilling. The Drill Bit 2.4mm (PS1705.006) and Drill Bit 2.7mm (PS1705.007) create the pilot hole in the occipital bone at the calibrated depth limited by the Drill Sleeve (PS1705.001), which prevents the drill from advancing beyond the outer cortical thickness into the inner table. The Screw Tap Ø3.5mm (PS1705.021) and Screw Tap Ø4.0mm (PS1705.026) thread the occipital drill hole before screw insertion — the dense cortical bone of the occiput benefits from pre-tapping to ensure accurate screw advancement without excess rotational force on the surrounding cortical shell. The Depth Gauge (PS1705.076) measures the cortical depth for screw length selection before screw insertion. The Marker Pin ×6 (PS1705.046) and Marker Pin Inserter (PS1705.051) place temporary position markers at intended screw sites on the occipital plate to confirm final plate positioning before drilling.

Posterior Cervical Screw and Probe Instruments

The Screwdriver for Posterior Cervical Screw (PS1705.011) is the primary screw insertion instrument for the lateral mass and/or pedicle screws placed in the cervical vertebrae below C2 — these screws connect the rod from the occipital plate down through the subaxial cervical spine to the stable fusion levels below the craniocervical junction pathology. The Probe Straight (PS1705.086) is used to palpate the lateral mass or pedicle channel after the initial awl entry and before screw insertion, confirming the channel walls are intact without perforation of the transverse foramen (lateral) or the spinal canal (medial). The Probe Curved (PS1705.091) reaches the curved trajectories of lateral mass screws in the subaxial cervical spine, where the screw must converge toward the lateral cortex of the lateral mass at a defined angle to the sagittal plane to avoid the adjacent nerve root foramen. The Sleeve (PS1705.081) provides soft tissue protection during drilling and screw insertion at each cervical level. The Elevator (PS1705.151) assists with subperiosteal dissection and lateral mass exposure during the posterior cervical approach. The Inner Holder (PS1705.016), Inner Tightener (PS1705.031), and Screw Holder with Lock (PS1705.146) manage the tulip head engagement and final set screw locking at each pedicle or lateral mass screw in the construct.

Rod System: Template, Benders, Holder, Rocker, Pusher, Gripper, Persuader, Cutter, Compressor, Distractor

The rod instrumentation in this set covers the complete sequence from rod length selection through final rod seating and segmental alignment adjustment. The Rod Template (PS1705.111) is a malleable template used to measure the required rod length and curvature by bending it to match the screw head positions from the occipital plate to the lowest fusion level — the shaped template is then used as a reference to contour the definitive rod before insertion. The two Rod Benders (PS1705.106 ×2) and additional Rod Bender (PS1705.141) provide the instruments for ex-situ rod contouring to the planned craniocervical and cervical sagittal profile. The Rod Holder (PS1705.096) grips the rod for controlled introduction into the deep posterior wound from the occiput to the subaxial cervical screw levels. The Rod Rocker (PS1705.101) adjusts the seated rod laterally to engage screw tulip heads that are not perfectly aligned with the rod axis. The Rod Pusher open (PS1705.061) and Rod Pusher Close (PS1705.071) seat the rod into the screw tulip at each level sequentially, providing the directed force needed to advance the rod into the tulip without transmitting rotation to the screw. The Rod Gripper (PS1705.131) maintains rod position during tulip seating at difficult-to-access posterior cranial junction levels. The Persuader (PS1705.136) applies the final controlled force to seat a rod into a screw tulip that is slightly misaligned or resisting engagement. The Compressor (PS1705.116) applies controlled compression between adjacent screw levels along the seated rod for segmental alignment optimisation. The Distractor (PS1705.121) applies distraction for height restoration or foraminal opening at any level. The Rod Cutter (PS1705.126) trims the rod to the correct length in situ after final positioning.

CE Mark, ISO 13485, and FDA Certification for Craniocervical Fixation Procurement

The Occipital Cervical Fixation System Set is manufactured under CE Mark, ISO 13485, and FDA compliant quality standards. ISO 13485 certification confirms Peak Surgicals operates a documented quality management system covering design control, material traceability, and production consistency for spinal surgical instruments. CE Mark confirms conformity with European medical device regulations, and FDA compliance supports procurement for US-based hospitals, spine surgery centers, and neurosurgical departments requiring verified regulatory documentation for posterior craniocervical fixation instrumentation purchases.

Product Specifications

Frequently Asked Questions

What conditions require occipital-cervical fixation?
Posterior occipital-cervical fixation is indicated for conditions that produce instability or deformity at the craniocervical junction — the anatomical region between the base of the skull (occiput) and the upper cervical spine (C1, C2, and subaxial cervical vertebrae). Primary indications include traumatic craniocervical dissociation and occipital condyle fractures with instability; atlantoaxial instability from odontoid fractures, os odontoideum, C1-C2 ligamentous disruption, or failed prior posterior C1-C2 fixation; rheumatoid arthritis with cranial settling, atlantoaxial subluxation, and subaxial cervical instability requiring long-segment posterior fusion; basilar invagination requiring posterior decompression and fixation; Chiari malformation with craniovertebral junction instability; tumour involvement of the occipital condyle, C1, or C2 requiring posterior reconstructive fixation; and osteomyelitis or discitis at the craniocervical junction destroying the bony ring of C1 or the dens. The occipital plate is fixed to the occiput with the screws prepared using this instrument set, and the connecting rods span from the plate to lateral mass or pedicle screws in the subaxial cervical spine below the pathological level.

What is the role of the Marker Pins in this set?
The six Marker Pins (PS1705.046) and the Marker Pin Inserter (PS1705.051) are used to mark the intended screw positions on the exposed occipital bone and cervical lateral masses before the occipital plate is positioned. The surgeon inserts a marker pin at each intended screw site under fluoroscopic guidance to confirm the anatomical positions — confirming the paramedian occipital screw positions are lateral to the midline sinus, within the occipital bone thickness, and away from the transverse sinuses, and that the cervical lateral mass screw positions correspond to the plate and rod dimensions. Once all screw positions are confirmed with the marker pins in place and the plate positioned over them, the marker pins are removed and the definitive drilling and screw insertion sequence begins. This prevents the need to reposition the plate after drilling begins, reducing operative time and the risk of plate malposition that would require new screw holes in adjacent bone.

Why are two drill bit sizes (2.4mm and 2.7mm) included?
The two drill bit diameters correspond to the pilot hole requirements of the 3.5mm and 4.0mm screws respectively — a 2.4mm pilot hole is used before the 3.5mm tap and a 2.7mm pilot hole before the 4.0mm tap. The choice between 3.5mm and 4.0mm screws at each position depends on the available occipital bone cortical thickness — measured using the Depth Gauge and confirmed fluoroscopically — and the cancellous bone density. In the occipital bone, the outer cortical table is typically 5–12mm thick in the paramedian region superior to the external occipital protuberance and thinner in the inferior paramedian regions. The surgeon selects the screw diameter that provides bicortical or near-bicortical purchase without inner table penetration at each individual screw site, and the corresponding drill bit prepares the correct pilot hole for that screw size.

How does this set relate to the Spinal Pedicle Screw System also available from Peak Surgicals?
The Spinal Pedicle Screw System from Peak Surgicals provides the general-purpose posterior spinal pedicle screw-rod fixation instruments for lumbar and thoracic spinal fusion — taps Ø4–7mm, pedicle probes, rod bender, in-situ bending iron, parallel spreader and compressor. The Occipital Cervical Fixation System Set is a dedicated craniocervical junction instrument set configured for the specific anatomy of the occiput and upper cervical spine — small-diameter drill bits (2.4mm and 2.7mm) for the thin occipital cortical shell, 3.5mm and 4.0mm taps rather than the 4–7mm range of the lumbar system, pointed and flat awls specific to cortical bone entry on the occipital surface, marker pins for plate positioning, and a probe curved specifically for subaxial cervical lateral mass trajectories rather than pedicle trajectories. The rod management instruments — Rod Template, Rod Rocker, Persuader, Rod Pusher (open and close) — are also configured for the confined posterior craniocervical surgical corridor. Centres performing craniocervical fixation require this dedicated set in addition to any general lumbar or thoracic pedicle screw set.

What certifications does this set carry?
The Occipital Cervical Fixation System Set is manufactured under CE Mark, ISO 13485, and FDA compliant quality standards. ISO 13485 certification confirms Peak Surgicals operates a documented quality management system covering design control, material traceability, and manufacturing consistency for spinal surgical instruments. CE Mark confirms conformity with European medical device regulations, and FDA compliance supports procurement for US hospitals, spine surgery centers, and neurosurgical departments requiring verified regulatory documentation for craniocervical fixation instrumentation purchases.