Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up.
Atlantoaxial instability
Craniovertebral junction
Occipitocervical fixation
Transoral surgery
Journal
European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
ISSN: 1432-0932
Titre abrégé: Eur Spine J
Pays: Germany
ID NLM: 9301980
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
received:
29
05
2021
accepted:
18
10
2021
revised:
18
07
2021
pubmed:
3
11
2021
medline:
7
4
2022
entrez:
2
11
2021
Statut:
ppublish
Résumé
Occipitocervical fusion is necessary for many pathologies of the craniocervical junction. The anatomy of the region is unique, and fusion can cause significant morbidity. This retrospective review aims to investigate the complication rates and outcomes of occipitocervical fixation. This is a retrospective review of 128 patients with occipitocervical fixation operated between 1994 and 2020. The average follow-up is 63 months. The indications of occipitocervical fixation were basilar invagination (53 patients; 41.4%), trauma (25 patients; 19.5%), tumor (23 patients; 18%), instability due to rheumatoid arthritis (13 patients; 10.2%), cervical deformity (7 patients; 5.5%) and os odontoideum (7 patients; 5.5%). There were six early postoperative (1st month) deaths. We observed complications in 67 patients (52%). Most common complication was implant-related (32%), followed by wound problems (23.4%), systemic and other complications (11.7%), neurologic complications (6.2%). Implants are removed in 31 patients (24%) for different reasons: deep wound infection (7), local pain and restriction of head movements (21), respiratory distress and swallowing problems (2), screw fracture and local pain (1). Occipitocervical fixation has quite large number of complications and significantly restricts head movements. With the advent of our biomechanical concepts, indications should be limited, and shorter cervical fixations should be preferred. Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.
Identifiants
pubmed: 34725722
doi: 10.1007/s00586-021-07037-2
pii: 10.1007/s00586-021-07037-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
311-326Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
Références
Deutsch H, Haid RW Jr, Rodts GE Jr, Mummaneni PV (2005) Occipitocervical fixation: long-term results. Spine (Phila Pa 1976) 30(5):530–535. https://doi.org/10.1097/01.brs.0000154715.88911.ea
doi: 10.1097/01.brs.0000154715.88911.ea
Lu DC, Roeser AC, Mummaneni VP, Mummaneni PV (2010) Nuances of occipitocervical fixation. Neurosurgery. https://doi.org/10.1227/01.NEU.0000365744.54102.B9
doi: 10.1227/01.NEU.0000365744.54102.B9
pubmed: 20881570
Nockels RP, Shaffrey CI, Kanter AS, Azeem S, York JE (2007) Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine 7(2):117–123. https://doi.org/10.3171/SPI-07/08/117
doi: 10.3171/SPI-07/08/117
pubmed: 17688049
Zileli M, Çağlı S (2002) Combined anterior and posterior approach for managing basilar invagination associated with type I Chiari malformation. J Spinal Disord Tech 15:284–289. https://doi.org/10.1097/00024720-200208000-00004
doi: 10.1097/00024720-200208000-00004
pubmed: 12177543
Goel A (2004) Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 1:281–286. https://doi.org/10.3171/spi.2004.1.3.0281
doi: 10.3171/spi.2004.1.3.0281
pubmed: 15478366
Goel A (2010) Occipitocervical fixation: is it necessary? J Neurosurg Spine 13(1):1–2. https://doi.org/10.3171/2009.10.SPINE09761
doi: 10.3171/2009.10.SPINE09761
pubmed: 20594009
Ashafai NS, Visocchi M, Wąsik N (2019) Occipitocervical fusion: an updated review. Acta Neurochir Suppl 125:247–252. https://doi.org/10.1007/978-3-319-62515-7_35
doi: 10.1007/978-3-319-62515-7_35
pubmed: 30610329
Elia M, Mazzara JT, Fielding JW (1992) Onlay technique for occipitocervical fusion. Clin Orthop Relat Res 280:170–174
doi: 10.1097/00003086-199207000-00020
Martinez-Del-Campo E, Turner JD, Kalb S et al (2016) Occipitocervical fixation: a single surgeon’s experience with 120 patients. Neurosurgery. https://doi.org/10.1227/NEU.0000000000001340
doi: 10.1227/NEU.0000000000001340
pubmed: 27428783
Winegar CD, Lawrence JP, Friel BC et al (2010) A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine 13(1):5–16. https://doi.org/10.3171/2010.3.SPINE08143
doi: 10.3171/2010.3.SPINE08143
pubmed: 20594011
Bagley CA, Witham TF, Pindrik JA et al (2009) Assuring optimal physiologic craniocervical alignment and avoidance of swallowing-related complications after occipitocervical fusion by preoperative halo vest placement. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e318168be6f
doi: 10.1097/BSD.0b013e318168be6f
pubmed: 19412018
Visocchi M, Mattogno PP, Signorelli F, Zhong J, Iacopino G, Barbagallo G (2017) Complications in craniovertebral junction instrumentation: hardware removal can be associated with long-lasting stability. Personal Exp Acta Neurochir Suppl 124:187–194. https://doi.org/10.1007/978-3-319-39546-3_29
doi: 10.1007/978-3-319-39546-3_29
Cohen LL, Yang BW, Glotzbecker MP et al (2020) Occipital plate fixation in the pediatric population. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001564
doi: 10.1097/BPO.0000000000001564
pubmed: 33044376
Crostelli M, Mariani M, Mazza O et al (2009) Cervical fixation in the pediatric patient: our experience. Eur Spine J 18:20–28. https://doi.org/10.1007/s00586-009-0980-2
doi: 10.1007/s00586-009-0980-2
pubmed: 19404690
pmcid: 2899601
Hedequist D (2015) Modern instrumentation of the pediatric occiput and upper cervical spine. HSS J 11:9–14. https://doi.org/10.1007/s11420-014-9398-4
doi: 10.1007/s11420-014-9398-4
pubmed: 25737663
Geck MJ, Truumees E, Hawthorne D et al (2014) Feasibility of rigid upper cervical instrumentation in children: tomographic analysis of children aged 2–6. J Spinal Disord Tech 27:110–117. https://doi.org/10.1097/BSD.0b013e318291ce46
doi: 10.1097/BSD.0b013e318291ce46
He B, Yan L, Xu Z, Chang Z, Hao D (2014) The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis. Eur Spine J. https://doi.org/10.1007/s00586-014-3354-3
doi: 10.1007/s00586-014-3354-3
pubmed: 25323137
Stone JG, Panczykowski DM, Tempel ZJ et al (2015) Evaluation of occipitocervical arthrodesis rates with screw-based fixation and osteoinductive fusion adjuncts. J Neurol Surg A Cent Eur Neurosurg. https://doi.org/10.1055/s-0035-1547359
doi: 10.1055/s-0035-1547359
pubmed: 26171793
Garrido BJ, Myo GK, Sasso RC (2011) Rigid versus nonrigid occipitocervical fusion: a clinical comparison of short-term outcomes. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e3181cc90f2
doi: 10.1097/BSD.0b013e3181cc90f2
pubmed: 21270625
Zou X, Ouyang B, Yang H, Wang B, Ge S, Chen Y, Ni L, Zhang S, Xia H, Yang J, Ma X (2020) Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation. BMC Musculoskelet Disord 21(1):825
doi: 10.1186/s12891-020-03838-6
Wenning KE, Hoffmann MF (2020) Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? J Orthop Surg Res. https://doi.org/10.1186/s13018-019-1525-y
doi: 10.1186/s13018-019-1525-y
pubmed: 32762704
pmcid: 7412640
Theologis AA, Deviren V, Tay B (2017) Temporary fusionless posterior occipitocervical fixation for a proximal junctional type II odontoid fracture after previous C2-pelvis fusion: case report, description of a new surgical technique, and review of the literature. Eur Spine J. https://doi.org/10.1007/s00586-017-5093-8
doi: 10.1007/s00586-017-5093-8
pubmed: 28409288
Guo Q, Deng Y, Wang J et al (2016) Comparison of clinical outcomes of posterior C1–C2 temporary fixation without fusion and C1–C2 fusion for fresh odontoid fractures. Neurosurgery 78:77–83. https://doi.org/10.1227/NEU.0000000000001006
doi: 10.1227/NEU.0000000000001006
pubmed: 26348006
Han B, Li F, Chen G et al (2015) Motion preservation in type II odontoid fractures using temporary pedicle screw fixation: a preliminary study. Eur Spine J 24:686–693. https://doi.org/10.1007/s00586-014-3693-0
doi: 10.1007/s00586-014-3693-0
pubmed: 25543916
Yang JJ, Park S, Yoon JY, Mun JW (2020) Temporary bridge occipitocervical fixation for comminuted atlantoaxial fracture. World Neurosurg. https://doi.org/10.1016/j.wneu.2020.04.122
doi: 10.1016/j.wneu.2020.04.122
pubmed: 33348099
pmcid: 7438385