J Korean Neurosurg Soc.  2013 Apr;53(4):223-227. 10.3340/jkns.2013.53.4.223.

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

• Choi SH
• Lee SG
• Park CW
• Kim WK
• Yoo CJ
• Son S

• KMID: 1426208
• DOI: http://doi.org/10.3340/jkns.2013.53.4.223

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.

Keyword

Atlanto-occipital joint; Postoperative complications; Cerebral palsy; Rheumatoid arthritis

MeSH Terms

Arthritis, Rheumatoid
Atlanto-Occipital Joint
Cerebral Palsy
Consensus
Follow-Up Studies
Humans
Postoperative Complications
Reference Values
Reoperation
Vertebral Artery
Wound Infection

Figure

• 

  Fig. 1 Occipital screw failure in cerebral palsy patient. A : Occipital screw failure occurred at occipital plate during follow up period. B : Post reoperation plain X-ray.

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