Background: Occipitocervical fusion (OCF) using screws and rods offers immediate stability and an high fusion rates. However, multiple cranial fixation points are required in order to compensate for the poor bony purchase. Methods: The aim of this study was to compare the occipital condyle screw with the standard OCF techniques as well as to compare available techniques of the occipital condyle screw insertion. Materials and Methods: A comprehensive “Medline” and “Web of science” database search was performed. Cadaveric, radiographic and case studies were included. Results: The occipital condyle screw in comparison to the occipital plate enables an increased screw length, greater screw pullout strength, lower profile of the hardware and extended grafting surface. Both constructs have similar biomechanical properties (range of motion restriction, stiffness). Proximity of the vertebral artery and hypoglossal canal presents the greatest technical challenge of occipital condyle screw. Four surgical techniques with different entry points, cranial-caudal and medial angulations were described. None of these techniques is superior to the other. Conclusions: Occipital condyle screw is a viable alternative to standard OCF techniques. Challenges exist due to the proximity of the vital anatomical structures. Choice between four available techniques depends on unique patient’s anatomy