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SA Orthopaedic Journal

Print version ISSN 1681-150X

Abstract

BICK, Simon  and  DUNN, Robert. Occipito-cervical fusion: review of surgical indications, techniques and clinical outcomes. SA orthop. j. [online]. 2010, vol.9, n.4, pp. 26-32. ISSN 1681-150X.

STUDY DESIGN: A retrospective review of patients undergoing single-surgeon occipito-cervical fusion. OBJECTIVE: The aim of this study is to evaluate the surgical indications, techniques and clinical outcomes of occipito-cervical fusion, including C2 fixation methods and complications. MATERIALS AND METHOD: Thirty-four consecutive patients (16 males, 18 females) who underwent occipito-cervical fusion were reviewed. The indications for fusion were instability due to inflammatory diseases (13), trauma (9), congenital abnormalities (9), infections (2) and tumours (1). Nine patients (all but 1 paediatric) underwent fusion with bone grafting and halo immobilisation. Twenty-five patients underwent posterior instrumented fusion. Halo removal was performed after 6 weeks and soft collars were worn for 6 weeks in the instrumented group. Surgical techniques and clinical outcomes (stability, fusion, complications) were reviewed. RESULTS: Clinical and radiological fusion was attained in all patients available for follow-up, with an average of 2.7 months in the uninstrumented group and 5.2 months in the instrumented group. All fusions resulted in resolution of preoperative pain and an improvement in pre-operative neurology. Two patients demised in the acute postoperative period as a result of the underlying pathology. Eighteen patients required simultaneous decompressions. No instrumentation failures occurred. Superficial wound sepsis occurred in 4 patients, one subsequently requiring instrumentation removal. CONCLUSION: Occipito-cervical fusion is a safe and reliable procedure, predictably providing stability and improvement in preoperative pain and neurology. Multiple cervical fixation options are available according to surgeon preference and anatomical variants.

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