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Occipitocervical Surgery Complication

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Spinal Deformity
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Abstract

Indications for occipitocervical fusion include spinal cord compression and instability of the osteoligamentous complex. Etiologies may include trauma, tumor, infection, inflammatory disorders, degenerative disorders, and congenital disorders. X-ray, CT, and MRI modalities may play a role in diagnosing occipitocervical instability, cord compression, and basilar invagination. A thorough understanding of the anatomy is requisite for surgical success. This includes the bony and ligamentous anatomy as well as the vascular anatomy of the vertebral and internal carotid artery. This chapter reviews pearls and pitfalls in complication avoidance of the occipitocervical junction.

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References

  1. Martin MD, Bruner HJ, Maiman DJ. Anatomic and biomechanical considerations of the craniovertebral junction. Neurosurgery. 2010;66(3 Suppl):2–6.

    Article  PubMed  Google Scholar 

  2. Moore KL, Dalley AF, Agur AMR. Clinically oriented anatomy. 7th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014. xxviii, 1134 p. p.

    Google Scholar 

  3. Tubbs RS, Hallock JD, Radcliff V, Naftel RP, Mortazavi M, Shoja MM, et al. Ligaments of the craniocervical junction. J Neurosurg Spine. 2011;14(6):697–709.

    Article  PubMed  Google Scholar 

  4. Greenberg MS, Greenberg MS. Handbook of neurosurgery. 7th ed. Tampa: Greenberg Graphics; 2010. xiv, 1337 p. p.

    Google Scholar 

  5. Osborn AG. Introduction to cerebral angiography. Hagerstown: Harper & Row; 1980. xi, 436 p. p.

    Google Scholar 

  6. Eskander MS, Drew JM, Aubin ME, Marvin J, Franklin PD, Eck JC, et al. Vertebral artery anatomy: a review of two hundred fifty magnetic resonance imaging scans. Spine (Phila Pa 1976). 2010;35(23):2035–40.

    Article  Google Scholar 

  7. Argenson CF, Francke JP, Sylla S, Dintimille H, Papasian S, DiMarino V. The vertebral arteries (segments V1 and V2). Anat Clin. 1980;2:29–41.

    Article  Google Scholar 

  8. Mohamed E, Ihab Z, Moaz A, Ayman N, Haitham AE. Lateral mass fixation in subaxial cervical spine: anatomic review. Global Spine J. 2012;2(1):39–46.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Curylo LJ, Mason HC, Bohlman HH, Yoo JU. Tortuous course of the vertebral artery and anterior cervical decompression: a cadaveric and clinical case study. Spine (Phila Pa 1976). 2000;25(22):2860–4.

    Article  CAS  Google Scholar 

  10. Hong JT, Lee SW, Son BC, Sung JH, Yang SH, Kim IS, et al. Analysis of anatomical variations of bone and vascular structures around the posterior atlantal arch using three-dimensional computed tomography angiography. J Neurosurg Spine. 2008;8(3):230–6.

    Article  PubMed  Google Scholar 

  11. Harris JH Jr, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994;162(4):881–6.

    Article  PubMed  Google Scholar 

  12. Powers B, Miller MD, Kramer RS, Martinez S, Gehweiler JA Jr. Traumatic anterior atlanto-occipital dislocation. Neurosurgery. 1979;4(1):12–7.

    Article  CAS  PubMed  Google Scholar 

  13. Hogan GJ, Mirvis SE, Shanmuganathan K, Scalea TM. Exclusion of unstable cervical spine injury in obtunded patients with blunt trauma: is MR imaging needed when multi-detector row CT findings are normal? Radiology. 2005;237(1):106–13.

    Article  PubMed  Google Scholar 

  14. Spence KF Jr, Decker S, Sell KW. Bursting atlantal fracture associated with rupture of the transverse ligament. J Bone Joint Surg Am. 1970;52(3):543–9.

    Article  PubMed  Google Scholar 

  15. Hinck VC, Hopkins CE. Measurement of the atlanto-dental interval in the adult. Am J Roentgenol Radium Therapy, Nucl Med. 1960;84:945–51.

    CAS  Google Scholar 

  16. Oda T, Fujiwara K, Yonenobu K, Azuma B, Ochi T. Natural course of cervical spine lesions in rheumatoid arthritis. Spine (Phila Pa 1976). 1995;20(10):1128–35.

    Article  CAS  Google Scholar 

  17. McRae DL, Barnum AS. Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med. 1953;70(1):23–46.

    CAS  PubMed  Google Scholar 

  18. Chamberlain WE. Basilar impression (Platybasia): a bizarre developmental anomaly of the occipital bone and upper cervical spine with striking and misleading neurologic manifestations. Yale J Biol Med. 1939;11(5):487–96.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. McGreger M. The significance of certain measurements of the skull in the diagnosis of basilar impression. Br J Radiol. 1948;21(244):171–81.

    Article  CAS  PubMed  Google Scholar 

  20. Redlund-Johnell I, Pettersson H. Radiographic measurements of the cranio-vertebral region. Designed for evaluation of abnormalities in rheumatoid arthritis. Acta Radiol Diagn. 1984;25(1):23–8.

    Article  CAS  Google Scholar 

  21. Ranawat CS, O’Leary P, Pellicci P, Tsairis P, Marchisello P, Dorr L. Cervical spine fusion in rheumatoid arthritis. J Bone Joint Surg Am. 1979;61(7):1003–10.

    Article  CAS  PubMed  Google Scholar 

  22. Fischgold HM, J. Etude radiotomographique de l'impression basilaire. Rev Rhum Ed Fr. 1952;19:261–4.

    CAS  Google Scholar 

  23. Wackenheim A. Roentgen diagnosis of the craniovertebral region. Berlin: Springer; 1974. xxii, 601 p. p.

    Google Scholar 

  24. Riew KD, Hilibrand AS, Palumbo MA, Sethi N, Bohlman HH. Diagnosing basilar invagination in the rheumatoid patient. The reliability of radiographic criteria. J Bone Joint Surg Am. 2001;83-A(2):194–200.

    Article  CAS  PubMed  Google Scholar 

  25. VanGilder JC, Menezes AH, Dolan KD. The craniovertebral junction and its abnormalities. New York: Futura Pub. Co.; 1987. vii, 255 p. p.

    Google Scholar 

  26. Klimo P Jr, Rao G, Brockmeyer D. Congenital anomalies of the cervical spine. Neurosurg Clin N Am. 2007;18(3):463–78.

    Article  PubMed  Google Scholar 

  27. Cacciola F, Phalke U, Goel A. Vertebral artery in relationship to C1-C2 vertebrae: an anatomical study. Neurol India. 2004;52(2):178–84.

    PubMed  Google Scholar 

  28. Mummaneni PV, Lu DC, Dhall SS, Mummaneni VP, Chou D. C1 lateral mass fixation: a comparison of constructs. Neurosurgery. 2010;66(3 Suppl):153–60.

    Article  PubMed  Google Scholar 

  29. Jea A, Sheth RN, Vanni S, Green BA, Levi AD. Modification of Wright’s technique for placement of bilateral crossing C2 translaminar screws: technical note. Spine J. 2008;8(4):656–60.

    Article  PubMed  Google Scholar 

  30. Schroeder GD, Hsu WK. Vertebral artery injuries in cervical spine surgery. Surg Neurol Int. 2013;4(Suppl 5):S362–7.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Choi JW, Lee JK, Moon KS, Kim YS, Kwak HJ, Joo SP, et al. Endovascular embolization of iatrogenic vertebral artery injury during anterior cervical spine surgery: report of two cases and review of the literature. Spine (Phila Pa 1976). 2006;31(23):E891–4.

    Google Scholar 

  32. Gluf WM, Schmidt MH, Apfelbaum RI. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 191 adult patients. J Neurosurg Spine. 2005;2(2):155–63.

    Article  PubMed  Google Scholar 

  33. Sutterlin CE 3rd, Bianchi JR, Kunz DN, Zdeblick TA, Johnson WM, Rapoff AJ. Biomechanical evaluation of occipitocervical fixation devices. J Spinal Disord. 2001;14(3):185–92.

    Article  PubMed  Google Scholar 

  34. Vender JR, Rekito AJ, Harrison SJ, McDonnell DE. The evolution of posterior cervical and occipitocervical fusion and instrumentation. Neurosurg Focus. 2004;16(1):E9.

    Article  PubMed  Google Scholar 

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Correspondence to Dean Chou .

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Vogel, T., Chou, D. (2018). Occipitocervical Surgery Complication. In: Mummaneni, P., Park, P., Crawford III, C., Kanter, A., Glassman, S. (eds) Spinal Deformity . Springer, Cham. https://doi.org/10.1007/978-3-319-60083-3_2

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  • DOI: https://doi.org/10.1007/978-3-319-60083-3_2

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