Shimizu T, Fujibayashi S, Otsuki B, et al. - The retrospective case series was performed to explore the long-term radiographic outcome of patients who underwent occipitocervical fixation (OCF) applying a modern screw/rod system. Researchers retrospectively examined 22 patients who had undergone OCF with a modern screw-based construct. They evaluated baseline demographics and the following pre-and postoperative sagittal alignment parameters. Over an average 89.7-month follow-up, the CT-confirmed fusion rate of OCF was 77.2%. The results of this study indicated that compensatory sagittal alignment variation can occur in the unfused subaxial segments in conjunction with the alignment variation in the instrumented OC segments, whereas the horizontal gaze was maintained. During OCF, strong consideration for the intraoperative measurement of the O-C2 angle should be given to minimize both early and long-term complications.