title: Occipitocervical fixation: long-term results.
abstract: METHODS
  The study is a retrospective review of 58 patients who underwent occipitocervical fusion between 1997 and 2001.
  
  
  OBJECTIVE
  Our objective is to study the clinical results after occipitocervical fixation with long-term follow-up and assess factors contributing to clinical success.
  
  
  METHODS
  Data from patient charts, operative notes, physician office notes, and imaging studies were incorporated in the study. Myelopathy was assessed using a Nurick scale for preoperative and postoperative evaluation. Fusion was assessed using cervical plane films with flexion and extension views.
  
  
  RESULTS
  Mean follow-up was 36 months, with all patients having a greater than 1-year follow-up. The most common pathology was congenital cranial settling (41%) followed by trauma (22%) and rheumatoid arthritis (17%). Myelopathy was the most common presentation (62%) followed by pain (28%). A successful fusion occurred in 48 out of 51 patients (94%). Symptoms improved in 86% of patients, whereas 35% improved 1 Nurick grade. Complications occurred in 30% of patients. The cervical wound infection rate was 5%. The rate of adjacent level degeneration was 7%. The mortality rate was 1.7%.
  
  
  CONCLUSIONS
  Occipitocervical instrumentation allows for very high fusion rates without the need for halo vest immobilization. All patients with successful fixation have pain resolution. Myelopathy improves in most patients, whereas one-third of patients demonstrate dramatic improvement.
authors.affiliation: Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. hdeutsch@cinn.org
authors.forename: Harel
authors.initials: H
authors.lastname: Deutsch
authors.forename: Regis W
authors.initials: RW
authors.lastname: Haid
authors.forename: Gerald E
authors.initials: GE
authors.lastname: Rodts
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005592:Fracture Fixation / Q000295:instrumentation / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000000981:diagnostic imaging* / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation / Q000706:statistics & numerical data*; D018709:Statistics, Nonparametric; D013995:Time