title: Management of operative complications related to occipitocervical instrumentation.
abstract: BACKGROUND
  The continued evolution of instrumentation techniques for fusions at the craniovertebral junction has enabled surgical treatment of a wide range of developmental, neoplastic, traumatic, and degenerative conditions. There has been an increased recognition of the morbidity associated with the complications secondary to occipitocervical instrumentation.
  
  
  OBJECTIVE
  To present representative complications secondary to occipitocervical instrumentation in patients who presented to our institution and to emphasize underlying principles in diagnosis and management of craniovertebral disease conditions through illustrative examples of their presentation, management, and follow-up.
  
  
  METHODS
  Clinical records for patients referred to the senior author (A.H.M.) between 2005 and 2010 for evaluation and management of their symptoms arising as a consequence of surgical intervention by a different primary neurosurgeon were reviewed.
  
  
  RESULTS
  Eight patients were identified with representative complications secondary to occipitocervical instrumentation. These complications included incorrect surgical technique, persistent instability, hardware misplacement with potential for vascular injury, associated neural injury, and secondary complications of wound healing resulting from methyl methacrylate use. Surgical revision was required in 2 patients. The remaining patients improved with removal of the offending hardware and acrylic cement. All patients reported symptom resolution, and dynamic imaging studies on follow-up indicated stable alignment and bony fusion.
  
  
  CONCLUSIONS
  These cases serve as illustrative examples of the spectrum of neural, vascular, biomechanical, and instrument-related complications associated with occipitocervical arthrodesis. Basic principles of occipitocervical instrumentation that enable safe and successful treatment of craniovertebral junction disease conditions have been highlighted. Potential complications and management strategies are discussed.
authors: Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Carver College of Medicine, Iowa City, IA 52242, USA.
authors: Raheel
authors: R
authors: Ahmed
authors: Arnold H
authors: AH
authors: Menezes
mesh_terms: D000328:Adult; D001270:Cervical Atlas / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009777:Occipital Bone / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology* / Q000473:pathology; D012086:Reoperation; D013123:Spinal Fusion / Q000009:adverse effects* / Q000295:instrumentation; D055815:Young Adult