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Occipitocervical Fixation: Long-Term Results

2005; Lippincott Williams & Wilkins; Volume: 30; Issue: 5 Linguagem: Inglês

10.1097/01.brs.0000154715.88911.ea

1528-1159

Harel Deutsch, Regis W. Haid, Gerald E. Rodts, Praveen V. Mummaneni,

Spine and Intervertebral Disc Pathology

In Brief Study Design. The study is a retrospective review of 58 patients who underwent occipitocervical fusion between 1997 and 2001. Objectives Our objective is to study the clinical results after occipitocervical fixation with long-term follow-up and assess factors contributing to clinical success. Methods Data from patient charts, operative notes, physician office notes, and imaging studies were incorporated in the study. Myelopathy was assessed using a Nurick scale for preoperative and postoperative evaluation. Fusion was assessed using cervical plane films with flexion and extension views. Results Mean follow-up was 36 months, with all patients having a greater than 1-year follow-up. The most common pathology was congenital cranial settling (41%) followed by trauma (22%) and rheumatoid arthritis (17%). Myelopathy was the most common presentation (62%) followed by pain (28%). A successful fusion occurred in 48 out of 51 patients (94%). Symptoms improved in 86% of patients, whereas 35% improved 1 Nurick grade. Complications occurred in 30% of patients. The cervical wound infection rate was 5%. The rate of adjacent level degeneration was 7%. The mortality rate was 1.7%. Conclusions Occipitocervical instrumentation allows for very high fusion rates without the need for halo vest immobilization. All patients with successful fixation have pain resolution. Myelopathy improves in most patients, whereas one-third of patients demonstrate dramatic improvement. This study is a retrospective review of 58 patients undergoing occipitocervical fusion with a mean 36-month follow-up. High fusion rates (94%) are possible with occipitocervical instrumentation without requiring external halo vest stabilization. Significant neurologic improvement occurred in 35% of patients.