title: Neurological recovery after occipitocervical fixation.
abstract: OBJECTIVE
  To report on 14 consecutive cases of occipitocervical fixation.
  
  
  METHODS
  Records of 8 men and 6 women aged 40 to 81 (mean, 57) years who underwent occipitocervical fixation and were followed up for a minimum of 2 years were retrospectively reviewed. Neurological grading was assessed before and after surgery using the Ranawat grade. Intra-operative somatosensory evoked potentials were monitored.
  
  
  RESULTS
  The main indications for surgery were rheumatoid arthritis (n=6) and cervical metastasis (n=4). 77% of the patients demonstrated neurological improvement. Four out of the 5 non-ambulatory patients (Ranawat grade IIIB) regained ambulatory status postoperatively. No patient had neurological deterioration or evidence of vertebral artery or spinal cord injury. One endured a superficial wound infection and 2 had implant breakage.
  
  
  CONCLUSIONS
  Although occipitocervical fixation is technically challenging and there are risks of serious neurologic or vascular complications, it remains a viable option with favourable results in patients requiring stabilisation of the craniocervical junction.
authors.affiliation: Department of Orthopaedic Surgery, National University Hospital, Singapore.
authors.forename: K J
authors.initials: KJ
authors.lastname: Tan
authors.forename: H T
authors.initials: HT
authors.lastname: Hee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D001859:Bone Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome