Mehmet Zileli1, Nevhis Akıntürk2. 1. Ege University Neurosurgery Department, Bornova, Izmir, Turkey. zilelim@gmail.com. 2. Ege University Neurosurgery Department, Bornova, Izmir, Turkey.
Abstract
PURPOSE: Occipitocervical fusion is necessary for many pathologies of the craniocervical junction. The anatomy of the region is unique, and fusion can cause significant morbidity. This retrospective review aims to investigate the complication rates and outcomes of occipitocervical fixation. MATERIAL AND METHODS: This is a retrospective review of 128 patients with occipitocervical fixation operated between 1994 and 2020. The average follow-up is 63 months. RESULTS: The indications of occipitocervical fixation were basilar invagination (53 patients; 41.4%), trauma (25 patients; 19.5%), tumor (23 patients; 18%), instability due to rheumatoid arthritis (13 patients; 10.2%), cervical deformity (7 patients; 5.5%) and os odontoideum (7 patients; 5.5%). There were six early postoperative (1st month) deaths. We observed complications in 67 patients (52%). Most common complication was implant-related (32%), followed by wound problems (23.4%), systemic and other complications (11.7%), neurologic complications (6.2%). Implants are removed in 31 patients (24%) for different reasons: deep wound infection (7), local pain and restriction of head movements (21), respiratory distress and swallowing problems (2), screw fracture and local pain (1). CONCLUSIONS: Occipitocervical fixation has quite large number of complications and significantly restricts head movements. With the advent of our biomechanical concepts, indications should be limited, and shorter cervical fixations should be preferred. LEVEL OF EVIDENCE: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
PURPOSE: Occipitocervical fusion is necessary for many pathologies of the craniocervical junction. The anatomy of the region is unique, and fusion can cause significant morbidity. This retrospective review aims to investigate the complication rates and outcomes of occipitocervical fixation. MATERIAL AND METHODS: This is a retrospective review of 128 patients with occipitocervical fixation operated between 1994 and 2020. The average follow-up is 63 months. RESULTS: The indications of occipitocervical fixation were basilar invagination (53 patients; 41.4%), trauma (25 patients; 19.5%), tumor (23 patients; 18%), instability due to rheumatoid arthritis (13 patients; 10.2%), cervical deformity (7 patients; 5.5%) and os odontoideum (7 patients; 5.5%). There were six early postoperative (1st month) deaths. We observed complications in 67 patients (52%). Most common complication was implant-related (32%), followed by wound problems (23.4%), systemic and other complications (11.7%), neurologic complications (6.2%). Implants are removed in 31 patients (24%) for different reasons: deep wound infection (7), local pain and restriction of head movements (21), respiratory distress and swallowing problems (2), screw fracture and local pain (1). CONCLUSIONS: Occipitocervical fixation has quite large number of complications and significantly restricts head movements. With the advent of our biomechanical concepts, indications should be limited, and shorter cervical fixations should be preferred. LEVEL OF EVIDENCE: Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Authors: Corbett D Winegar; James P Lawrence; Brian C Friel; Carmella Fernandez; Joseph Hong; Mitchell Maltenfort; Paul A Anderson; Alexander R Vaccaro Journal: J Neurosurg Spine Date: 2010-07
Authors: Lara L Cohen; Richard M Schwend; John M Flynn; Daniel J Hedequist; Lawrence I Karlin; John B Emans; Brian D Snyder; Michael T Hresko; John T Anderson; Julia Leamon; Divya Talwar; Michael P Glotzbecker Journal: J Pediatr Orthop Date: 2020 Nov/Dec Impact factor: 2.324
Authors: Eduardo Martinez-Del-Campo; Jay D Turner; Samuel Kalb; Leonardo Rangel-Castilla; Luis Perez-Orribo; Hector Soriano-Baron; Nicholas Theodore Journal: Neurosurgery Date: 2016-10 Impact factor: 4.654
Authors: Carlos A Bagley; Timothy F Witham; Jonathan A Pindrik; Randy F Davis; Ali Bydon; Ziya L Gokaslan; Jean-Paul Wolinsky Journal: J Spinal Disord Tech Date: 2009-05