Massimiliano Visocchi1, Pier Paolo Mattogno2, Francesco Signorelli1, Jun Zhong3, Gerardo Iacopino4, Giuseppe Barbagallo5. 1. Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy. 2. Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy. pierpaolo.mattogno@gmail.com. 3. Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092, China. 4. Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy. 5. Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
Abstract
BACKGROUND: The causes of craniovertebral junction (CVJ) instabilities include trauma, rheumatological diseases, tumors, infections, congenital malformations, and degenerative disease processes; these complex pathologies often require CVJ instrumentation. Hardware complications were analyzed in a personal series of 48 treated patients. In light of the analysis of very unusual radiological and clinical findings, the authors tried to better investigate the related mechanisms and to reach possible useful conclusions. METHODS: In a series of 48 patients who underwent CVJ instrumentation and fusion procedures in our Institution, we describe three cases of hardware failure, due to: (1) infection; (2) radio- and chemotherapy; and (3) incorrect surgical procedure. RESULTS: 1. A stable bone CVJ fusion can occur after instrumentation removal for infection, since this removal can enhance bone fusion mechanisms; 2. Radio- and chemotherapy can cause hardware failure due to interference with local bone metabolism; 3. Although old-fashioned, wiring techniques still deserve consideration, mostly in CVJ re-do surgery after screwing technique failures; nevertheless, although the procedure is simple, safe, and effective, care must be taken in the preparation of the cranial holes in order to avoid sliding complications of the U-shaped rods. CONCLUSIONS: CVJ instrumentations provide reasonably good mechanical stabilization with a high rate of bony fusion. Complications, such as dislocation or rupture of the fixation system, screw loosening, dural fistula, neural or vascular damage, and wound infection, are relatively infrequent. Knowledge and prevention of these complications is fundamental to improve surgical results and outcomes.
BACKGROUND: The causes of craniovertebral junction (CVJ) instabilities include trauma, rheumatological diseases, tumors, infections, congenital malformations, and degenerative disease processes; these complex pathologies often require CVJ instrumentation. Hardware complications were analyzed in a personal series of 48 treated patients. In light of the analysis of very unusual radiological and clinical findings, the authors tried to better investigate the related mechanisms and to reach possible useful conclusions. METHODS: In a series of 48 patients who underwent CVJ instrumentation and fusion procedures in our Institution, we describe three cases of hardware failure, due to: (1) infection; (2) radio- and chemotherapy; and (3) incorrect surgical procedure. RESULTS: 1. A stable bone CVJ fusion can occur after instrumentation removal for infection, since this removal can enhance bone fusion mechanisms; 2. Radio- and chemotherapy can cause hardware failure due to interference with local bone metabolism; 3. Although old-fashioned, wiring techniques still deserve consideration, mostly in CVJ re-do surgery after screwing technique failures; nevertheless, although the procedure is simple, safe, and effective, care must be taken in the preparation of the cranial holes in order to avoid sliding complications of the U-shaped rods. CONCLUSIONS: CVJ instrumentations provide reasonably good mechanical stabilization with a high rate of bony fusion. Complications, such as dislocation or rupture of the fixation system, screw loosening, dural fistula, neural or vascular damage, and wound infection, are relatively infrequent. Knowledge and prevention of these complications is fundamental to improve surgical results and outcomes.
Entities:
Keywords:
Bone infections; Craniovertebral junction; Occipito-cervical fusion; Screwing; Wiring
Authors: Ali Karadag; Pinar Gokdogan Kirgiz; Baran Bozkurt; Baris Kucukyuruk; Karim ReFaey; Erik H Middlebrooks; Mehmet Senoglu; Necmettin Tanriover Journal: Acta Neurochir (Wien) Date: 2021-04-13 Impact factor: 2.216
Authors: Rosario Maugeri; Roberto G Giammalva; Francesca Graziano; Luigi Basile; Carlo Gulì; Antonella Giugno; Domenico G Iacopino Journal: Surg Neurol Int Date: 2017-08-10