Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Outcomes and Complications after Occipito-Cervical Fusion Using the Screw-Rod System in Craniocervical Instability

  • Choi, Sung Ho (Department of Neurosurgery, Gachon University, Gil Hospita) ;
  • Lee, Sang Gu (Department of Neurosurgery, Gachon University, Gil Hospita) ;
  • Park, Chan Woo (Department of Neurosurgery, Gachon University, Gil Hospita) ;
  • Kim, Woo Kyung (Department of Neurosurgery, Gachon University, Gil Hospita) ;
  • Yoo, Chan Jong (Department of Neurosurgery, Gachon University, Gil Hospita) ;
  • Son, Seong (Department of Neurosurgery, Gachon University, Gil Hospita)
  • Received : 2012.12.13
  • Accepted : 2013.04.08
  • Published : 2013.04.28
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : Although there is no consensus on the ideal treatment of the craniocervical instability, biomechanical stabilization and bone fusion can be induced through occipito-cervical fusion (OCF). The authors conducted this study to evaluate efficacy of OCF, as well as to explore methods in reducing complications. Methods : A total of 16 cases with craniocervical instability underwent OCF since the year 2002. The mean age of the patients was 51.5 years with a mean follow-up period of 34.9 months. The subjects were compared using lateral X-ray taken before the operation, after the operation, and during last follow-up. The Nurick score was used to assess neurological function pre and postoperatively. Results : All patients showed improvements in myelopathic symptoms after the operation. The mean preoperative Nurick score was 3.1. At the end of follow-up after surgery, the mean Nurick score was 2.0. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. In two cases with cerebral palsy, occipital screw failures occurred. But, reoperation was performed in one case. Conclusion : OCF is an effective method in treating craniocervical instability. However, the complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. Much precaution should be taken when performing this procedure on high risk patients.

Keywords

References

  1. Abumi K, Takada T, Shono Y, Kaneda K, Fujiya M : Posterior occipitocervical reconstruction using cervical pedicle screws and plate-rod systems. Spine (Phila Pa 1976) 24 : 1425-1434, 1999 https://doi.org/10.1097/00007632-199907150-00007
  2. Behari S, Nayak SR, Bhargava V, Banerji D, Chhabra DK, Jain VK : Craniocervical tuberculosis : protocol of surgical management. Neurosurgery 52 : 72-80; discussion 80-81, 2003
  3. Boden SD, Dodge LD, Bohlman HH, Rechtine GR : Rheumatoid arthritis of the cervical spine. A long-term analysis with predictors of paralysis and recovery. J Bone Joint Surg Am 75 : 1282-1297, 1993 https://doi.org/10.2106/00004623-199309000-00004
  4. Carlson GD, Bohlman HH : Surgical techniques for occiput to C2 arthrodesis in Dillin WH, Simeone FA (eds) : Posterior Cervical Spine Surgery, ed 3. Philadelphia : Lippincott-Raven Publishers, 1998
  5. Clark CR, Goetz DD, Menezes AH : Arthrodesis of the cervical spine in rheumatoid arthritis. J Bone Joint Surg Am 71 : 381-392, 1989 https://doi.org/10.2106/00004623-198971030-00012
  6. Clark CR, Keggi KJ, Panjabi MM : Methylmethacrylate stabilization of the cervical spine. J Bone Joint Surg Am 66 : 40-46, 1984 https://doi.org/10.2106/00004623-198466010-00006
  7. Clements WD, Mezue W, Mathew B : Os odontoideum--congenital or acquired?--that's not the question. Injury 26 : 640-642, 1995 https://doi.org/10.1016/0020-1383(95)00123-Q
  8. Deutsch H, Haid RW Jr, Rodts GE Jr, Mummaneni PV : Occipitocervical fixation : long-term results. Spine (Phila Pa 1976) 30 : 530-535, 2005 https://doi.org/10.1097/01.brs.0000154715.88911.ea
  9. Ding X, Abumi K, Ito M, Sudo H, Takahata M, Nagahama K, et al. : A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J 21 : 1580-1589, 2012 https://doi.org/10.1007/s00586-012-2324-x
  10. Fehlings MG, Errico T, Cooper P, Benjamin V, DiBartolo T : Occipitocervical fusion with a five-millimeter malleable rod and segmental fixation. Neurosurgery 32 : 198-207; discussion 207-208, 1993 https://doi.org/10.1227/00006123-199302000-00008
  11. Grob D, Dvorak J, Panjabi MM, Antinnes JA : The role of plate and screw fixation in occipitocervical fusion in rheumatoid arthritis. Spine (Phila Pa 1976) 19 : 2545-2551, 1994 https://doi.org/10.1097/00007632-199411001-00009
  12. Grob D, Schutz U, Plotz G : Occipitocervical fusion in patients with rheumatoid arthritis. Clin Orthop Relat Res : 46-53, 1999
  13. Haher TR, Yeung AW, Caruso SA, Merola AA, Shin T, Zipnick RI, et al. : Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976) 24 : 5-9, 1999 https://doi.org/10.1097/00007632-199901010-00003
  14. Heidecke V, Rainov NG, Burkert W : Occipito-cervical fusion with the cervical Cotrel-Dubousset rod system. Acta Neurochir (Wien) 140 : 969-976, 1998 https://doi.org/10.1007/s007010050200
  15. Hong JM, Lee SG, Park CW, Yoo CJ, Kim WK : Tuberculosis of the craniovertebral junction with basilar impression : a case report. Korean J Spine 7 : 103-106, 2010
  16. Hsu YH, Liang ML, Yen YS, Cheng H, Huang CI, Huang WC : Use of screw-rod system in occipitocervical fixation. J Chin Med Assoc 72 : 20-28, 2009 https://doi.org/10.1016/S1726-4901(09)70015-2
  17. Jung JW, Lee SG, Kim IC, Yoo CJ, Kim WK, Park CW : A survived traumatic Atlanto-Occipital Dislocation. Korean J Spine 4 : 62-66, 2007
  18. Kim IS, Hong JT, Jang WY, Yang SH, Sung JH, Son BC, et al. : Surgical treatment of os odontoideum. J Clin Neurosci 18 : 481-484, 2011 https://doi.org/10.1016/j.jocn.2010.07.114
  19. Kim KN, Park KS, Kim HW, Chung CK : Progressive quadriparesis following a minor trauma in a patient with Klippel-Feil syndrome : case report. J Korean Neurosurg Soc 31 : 192-194, 2002
  20. Klimo P Jr, Kan P, Rao G, Apfelbaum R, Brockmeyer D : Os odontoideum : presentation, diagnosis, and treatment in a series of 78 patients. J Neurosurg Spine 9 : 332-342, 2008 https://doi.org/10.3171/SPI.2008.9.10.332
  21. Lal AP, Rajshekhar V, Chandy MJ : Management strategies in tuberculous atlanto-axial dislocation. Br J Neurosurg 6 : 529-535, 1992 https://doi.org/10.3109/02688699209002369
  22. McAfee PC, Cassidy JR, Davis RF, North RB, Ducker TB : Fusion of the occiput to the upper cervical spine. A review of 37 cases. Spine (Phila Pa 1976) 16 (10 Suppl) : S490-S494, 1991 https://doi.org/10.1097/00007632-199110001-00007
  23. Motosuneya T, Hirabayashi S, Yamada H, Sakai H : Occipitocervical fusion using a hook and rod system between cervical levels C2 and C3. J Clin Neurosci 16 : 909-913, 2009 https://doi.org/10.1016/j.jocn.2008.10.006
  24. Oda I, Abumi K, Sell LC, Haggerty CJ, Cunningham BW, McAfee PC : Biomechanical evaluation of five different occipito-atlanto-axial fixation techniques. Spine (Phila Pa 1976) 24 : 2377-2382, 1999 https://doi.org/10.1097/00007632-199911150-00015
  25. Paquis P, Breuil V, Lonjon M, Euller-Ziegler L, Grellier P : Occipitocervical fixation using hooks and screws for upper cervical instability. Neurosurgery 44 : 324-330; discussion 330-331, 1999 https://doi.org/10.1097/00006123-199902000-00042
  26. Riel RU, Lee MC, Kirkpatrick JS : Measurement of a posterior occipitocervical fusion angle. J Spinal Disord Tech 23 : 27-29, 2010 https://doi.org/10.1097/BSD.0b013e318198164b
  27. Sakou T, Kawaida H, Morizono Y, Matsunaga S, Fielding JW : Occipitoatlantoaxial fusion utilizing a rectangular rod. Clin Orthop Relat Res : 136-144, 1989
  28. Sasso RC, Jeanneret B, Fischer K, Magerl F : Occipitocervical fusion with posterior plate and screw instrumentation. A long-term follow-up study. Spine (Phila Pa 1976) 19 : 2364-2368, 1994 https://doi.org/10.1097/00007632-199410150-00021
  29. Shen FH, Samartzis D, Jenis LG, An HS : Rheumatoid arthritis : evaluation and surgical management of the cervical spine. Spine J 4 : 689-700, 2001
  30. Smith MD, Anderson P, Grady MS : Occipitocervical arthrodesis using contoured plate fixation. An early report on a versatile fixation technique. Spine (Phila Pa 1976) 18 : 1984-1990, 1993 https://doi.org/10.1097/00007632-199310001-00010
  31. Spierings EL, Braakman R : The management of os odontoideum. Analysis of 37 cases. J Bone Joint Surg Br 64 : 422-428, 1982
  32. Vaccaro AR, Lim MR, Lee JY : Indications for surgery and stabilization techniques of the occipito-cervical junction. Injury 36 Suppl 2 : B44-B53, 2005
  33. Vender JR, Houle PJ, Harrison S, McDonnell DE : Occipital-cervical fusion using the Locksley intersegmental tie bar technique : long-term experience with 19 patients. Spine J 2 : 134-141, 2002
  34. Wertheim SB, Bohlman HH : Occipitocervical fusion. Indications, technique, and long-term results in thirteen patients. J Bone Joint Surg Am 69 : 833-836, 1987 https://doi.org/10.2106/00004623-198769060-00006
  35. Yoon SM, Park CW, Yoo CJ, Kim WK, Lee SG : Kippel-Feil syndrome associated with various anomalies in the cervical spine. Korean J Spine 4 : 232-235, 2007

Cited by

  1. Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor vol.14, pp.None, 2013, https://doi.org/10.1186/1471-2482-14-30
  2. Occipitocervical fusion complicated with cerebellar abscess: a case report vol.21, pp.None, 2013, https://doi.org/10.1186/s12891-020-3157-0
  3. Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? vol.15, pp.None, 2013, https://doi.org/10.1186/s13018-019-1525-y
  4. An investigation of craniocervical stability post-condylectomy vol.12, pp.None, 2013, https://doi.org/10.25259/sni_456_2021
  5. Safety, efficacy, surgical, and radiological outcomes of short segment occipital plate and C2 transarticular screw construct for occipito-cervical instability vol.12, pp.4, 2013, https://doi.org/10.4103/jcvjs.jcvjs_113_21
  6. Application of Enhanced Recovery after Surgical Treatment of the Occipitocervical Region vol.13, pp.4, 2021, https://doi.org/10.1111/os.13018
  7. Occipitocervical fixation: A case report of our techniques and results vol.90, pp.None, 2022, https://doi.org/10.1016/j.ijscr.2021.106633