title: Complications in Craniovertebral Junction Instrumentation: Hardware Removal Can Be Associated with Long-Lasting Stability. Personal Experience.
abstract: The causes of craniovertebral junction (CVJ) instabilities include trauma, rheumatological diseases, tumors, infections, congenital malformations, and degenerative disease processes; these complex pathologies often require CVJ instrumentation. Hardware complications were analyzed in a personal series of 48 treated patients. In light of the analysis of very unusual radiological and clinical findings, the authors tried to better investigate the related mechanisms and to reach possible useful conclusions.
  
  
  
  In a series of 48 patients who underwent CVJ instrumentation and fusion procedures in our Institution, we describe three cases of hardware failure, due to: (1) infection; (2) radio- and chemotherapy; and (3) incorrect surgical procedure.
  
  
  
  1. A stable bone CVJ fusion can occur after instrumentation removal for infection, since this removal can enhance bone fusion mechanisms; 2. Radio- and chemotherapy can cause hardware failure due to interference with local bone metabolism; 3. Although old-fashioned, wiring techniques still deserve consideration, mostly in CVJ re-do surgery after screwing technique failures; nevertheless, although the procedure is simple, safe, and effective, care must be taken in the preparation of the cranial holes in order to avoid sliding complications of the U-shaped rods.
  
  
  
  CVJ instrumentations provide reasonably good mechanical stabilization with a high rate of bony fusion. Complications, such as dislocation or rupture of the fixation system, screw loosening, dural fistula, neural or vascular damage, and wound infection, are relatively infrequent. Knowledge and prevention of these complications is fundamental to improve surgical results and outcomes.
authors.affiliation: Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
authors.affiliation: Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy. pierpaolo.mattogno@gmail.com.
authors.forename: Pier Paolo
authors.initials: PP
authors.lastname: Mattogno
authors.affiliation: Institute of Neurosurgery, Medical School, Catholic University of Rome, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Signorelli
authors.affiliation: Department of Neurosurgery, XinHua Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, 200092, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.affiliation: Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Neurosurgical Clinic, University of Palermo, Palermo, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Iacopino
authors.affiliation: Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico" University Hospital, Catania, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Barbagallo
mesh_terms: D000293:Adolescent; D000970:Antineoplastic Agents / Q000009:adverse effects; D001268:Atlanto-Axial Joint / Q000002:abnormalities / Q000000981:diagnostic imaging / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D001368:Axis, Cervical Vertebra / Q000601:surgery*; D001859:Bone Neoplasms / Q000601:surgery; D001863:Bone Screws; D001864:Bone Wires; D000013:Congenital Abnormalities; D019299:Decompression, Surgical; D020878:Device Removal; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata; D008875:Middle Aged; D009809:Odontoid Process; D010954:Plasmacytoma / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000601:surgery*; D011859:Radiography; D011878:Radiotherapy / Q000009:adverse effects; D013123:Spinal Fusion; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents
keywords: Bone infections; Craniovertebral junction; Occipito-cervical fusion; Screwing; Wiring