Occipito-cervical fusion (OCF) is required when the junction is rendered unstable by a variety of pathological conditions including congenital abnormalities, inflammatory diseases, trauma, tumours and infections. Occipito -cervical instability ,neurological deficit intractable pain,atlanto-axial osteomyelitis ,Trauma ankylosing spondylitis , atlanto- occipital osteoarthritis.
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