Fusion of the occiput to the cervical spine is an infrequent but important procedure, as it provides the only permanent means of stabilization of the occipitocervical region. Occipitocervical fusion is commonly accompanied by an adjunctive procedure such as a decompression for stenotic disorders ora resection of pathologic material such as neoplasm, infection, or inflammatory pannus. Many techniques on obtaining an occipitocervical fusion, both with and without rigid internal fixation, have been described in the orthopaedic and neurosurgical literature and have evolved over time. These include simple onlay bone graft techniques, wire fixation with and without cement augmentation, malleable rod/wire constructs, and plate and screw fixation. A discussion of all described methods of occipitocervical fusion could fill an entire text. Therefore this article will focus on three primary methods: (1) occipitocervical wiring; (2) sublaminar and interspinous wire fixation about a contoured rod; and (3) plate and lateral mass screw fixation.