Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients.
OBJECTIVE
Instability of the occipitocervical junction may result from degenerative disease, infection, tumor, and trauma. Surgical stabilization involving screw fixation and rigid implants has been found to be biomechanically superior to wire-based implants. To evaluate the long-term results in a large and diverse patient population, the authors prospectively studied a consecutive group of 69 patients.


METHODS
All patients underwent occipitocervical fusion in which rigid posterior instrumentation included either plates or rods and screws. Patients ranged in age from 11 to 90 years (mean 51.4 years); there were 34 female and 35 male patients. The mean follow-up duration was 37 months (range 6-66 months). Fifty-seven (83%) of the 69 patients had long-standing occipitocervical anomalies, whereas the remainder presented with acute instability. Basilar invagination was present in 20 patients.


RESULTS
Correction of a severe cervical kyphotic deformity was accomplished in six patients. There were no fatalities or medical complications associated with the procedures. During the follow-up period, 87% of the patients exhibited improvement in their myelopathic symptoms; in 13% the symptoms were unchanged. Complications were minimal. Stability was demonstrated on flexion/extension studies in all cases. There were no treatment-related deaths, although four patients died within the follow-up period, all due to progression of metastatic disease.


CONCLUSIONS
The authors found that rigid internal fixation of the occipitocervical complex was safe, effective, and technically possible for spine surgeons familiar with occipital bone anatomy and lateral mass fixation.
Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois 60153, USA. rpnockels@mac.com
Russ P
RP
Nockels
Christopher I
CI
Shaffrey
Adam S
AS
Kanter
Syed
S
Azeem
Julie E
JE
York
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001847:Bone Diseases / Q000601:surgery; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D004868:Equipment Failure; D005260:Female; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D004204:Joint Dislocations / Q000601:surgery; D007738:Kyphosis / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009777:Occipital Bone / Q000601:surgery*; D010019:Osteomyelitis / Q000601:surgery; D011446:Prospective Studies; D013122:Spinal Diseases / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects; D020196:Trauma, Nervous System / Q000601:surgery; D016896:Treatment Outcome