Indications for occipital-cervical fusion are destruction by tumor, pathological instability and certain fracture dislocations of this region. For palliative surgery we prefer a combined fusion with tension band wire and bone cement; in curative procedures a well fitting cortical bone graft fixed by a circumferential tension band wiring is used. For occipital anchoring we suggest an epidural course of wires through 2 bore holes, in order to cervically fix a circumferential wire around the posterior arch of the vertebra.