title: Occipito-cervical fusion in post-traumatic instability of the upper cervical spine and cranio-cervical junction.
abstract: BACKGROUND
  Surgical management of upper cervical spine (UCS) unstable injuries may be challenging as the number of cases requiring this surgery collected in every single center is small. This retrospective study was conducted to analyze the radiographic and clinical results in 12 patients undergoing a posterior occipito-cervical fusion by a polyaxial screws-rod-plate system.
  
  
  METHODS
  There were eight male and four female patients with a mean age of 73.7 years (range 32-89 years). Six patients presented neurologic deficits at admission. Six patients had sustained major trauma. The remaining six patients had suffered a minor trauma.
  
  
  RESULTS
  Two patients died postoperatively in Intensive Care Unit. All surviving patients achieved solid fusion at 6 months. No surviving patient had neurological deterioration postoperatively. There were no instrumentation failures or revision required. Two patients suffered from superficial occipital wound infection.
  
  
  CONCLUSIONS
  Although the indication to occipito-cervical fusion decreased since the new C1-C2 posterior fixation techniques were described, it remains a valid and reliable option in UCS post-traumatic instability to be applied even in emergency especially in the elderly.
authors.affiliation: Department of Spine Surgery, Maggiore Hospital, Bologna, Italy, michele.cappuccio@libero.it.
authors.forename: Michele
authors.initials: M
authors.lastname: Cappuccio
authors.forename: Federico
authors.initials: F
authors.lastname: De Iure
authors.forename: Luca
authors.initials: L
authors.lastname: Amendola
authors.forename: Stefania
authors.initials: S
authors.lastname: Paderni
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bosco
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D001860:Bone Plates; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*
references.citation: J Bone Joint Surg Am. 1977 Apr;59(3):332-9
references.pmid: 849944
references.citation: Neurosurgery. 2010 Mar;66(3 Suppl):141-6
references.pmid: 20173517
references.citation: Eur Spine J. 1998;7(4):308-12
references.pmid: 9765039
references.citation: Injury. 2005 Jul;36 Suppl 2:B44-53
references.pmid: 15993117
references.citation: J Clin Neurosci. 2006 Feb;13(2):193-8
references.pmid: 16459085
references.citation: Spine (Phila Pa 1976). 1999 Jul 15;24(14):1425-34
references.pmid: 10423787
references.citation: Spine (Phila Pa 1976). 1997 Aug 15;22(16):1843-52
references.pmid: 9280020
references.citation: Neurosurgery. 2008 Nov;63(5):961-8; discussion 968-9
references.pmid: 19005387
references.citation: Neurosurgery. 1991 Apr;28(4):574-9
references.pmid: 2034353
references.citation: J Trauma. 2005 Aug;59(2):350-6; discussion 356-8
references.pmid: 16294074
references.citation: J Trauma. 2006 Jan;60(1):199-203
references.pmid: 16456456
references.citation: Neurosurgery. 2010 Mar;66(3 Suppl):7-12
references.pmid: 20173531
references.citation: Eur Spine J. 2008 Apr;17(4):585-91
references.pmid: 18196293
references.citation: AJR Am J Roentgenol. 2002 Mar;178(3):573-7
references.pmid: 11856676