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La radiologia medica

, Volume 117, Issue 4, pp 636–653 | Cite as

The role of imaging in the pre- and postoperative evaluation of posterior occipito-cervical fusion

  • A. LeoneEmail author
  • A. Costantini
  • M. Visocchi
  • A. Vestito
  • P. Colelli
  • N. Magarelli
  • C. Colosimo
  • L. Bonomo
Musculoskeletal Radiology / Radiologia Muscolo-Scheletrica

Abstract

Purpose

Occipitocervical fusion is required when the occipitoatlantal joint is unstable. The purpose of this paper is to discuss the role of imaging in the pre- and postoperative evaluation of posterior occipitocervical fusion (POCF), focusing on contoured loop fixation by Hartshill and Songer instrumentation.

Materials and methods

We studied 21 patients (eight males, 12 females; age range 6–70 years; mean age 32.6 years) with craniocervical instability who underwent POCF with Hartshill U-shaped rod and Songer sublaminar wires. Pre- and postoperative radiographic, computed tomography (CT) and magnetic resonance (MR) imaging examinations were performed in all patients. A 3-to 6-month period of external orthosis with halo vest, sterno-occipitalmandibular immobiliser (SOMI) brace or Philadelphia collar followed surgery. Follow-up was 12–96 (mean 53.1) months.

Results

Clinical assessment using the Frankel scale revealed improvement or deterioration arrest in all but two patients: one with C3 failure and halo destabilisation; the other, who had exhibited myelopathy signs on preoperative MR imaging and persistent basilar impression, showed increasing and progressive neurological deficits despite successful POCF.

Conclusions

Pre- and postoperative imaging is extremely useful in patients scheduled to undergo POCF. Preoperative MR screening of basilar impression associated with possible spinal cord lesions appears mandatory to predict possible deterioration and prevent undesired failure of the operation and it may suggest the need for an alternative surgical approach, such as the transoral approach.

Keywords

Craniocervical junction Instability Radiography CT MR imaging 

Ruolo dell’imaging nella valutazione pre- e post-chirurgica dell’artrodesi occipito-cervicale posteriore

Riassunto

Obiettivo

L’intervento di artrodesi occipito-cervicale posteriore (AOCP) è indicato nelle instabilità della giunzione cranio-cervicale. Scopo di questo lavoro è stato quello di valutare il ruolo dell’imaging pre- e post-operatorio nella AOCP, puntando l’attenzione sul posizionamento, per via posteriore, di fili sublaminari di Songer e barra a U di Hartshill.

Materiali e metodi

Sono stati studiati 21 pazienti (8 uomini, 13 donne; range d’età, 6–70 anni; età media, 32,6) con instabilità cranio-cervicale e sottoposti ad AOCP con posizionamento di barra ad U di Hartshill e fili sublaminari di Songer. Tutti i pazienti sono stati sottoposti ad esame radiografico, tomografia computerizzata (TC) e risonanza magnetica (RM) pre- e post-operatori. Dopo chirurgia, i pazienti sono stati trattati per 3–6 mesi con ortosi esterna (tutori Halo, Philadelphia o sternooccipital-mandibular immobilizers [SOMI]). Il follow-up è stato di 12–96 mesi (media, 53,1 mesi).

Risultati

La valutazione clinica, secondo la scala di Frankel, ha mostrato un miglioramento clinico o un arresto del deterioramento clinico in tutti i pazienti, tranne due. In uno di questi due pazienti, si è avuta una frattura di C3 con destabilizzazione dell’Halo; l’altro paziente, con segni di mielopatia all’esame RM pre-operatorio e con persistenza d’impressio basilaris, ha mostrato un progressivo peggioramento dei deficits neurologici nonostante una corretta AOCP.

Conclusioni

L’imaging pre- e post-operatorio è molto utile nei pazienti candidati ad AOCP. Lo screening RM pre- operatorio di impressio basilaris associata ad eventuali lesioni midollari è indispensabile per poter prevedere un peggioramento, prevenire un insuccesso chirurgico e per suggerire un approccio alternativo come quello transorale.

Parole chiave

Giunzione cranio-cervicale Instabilità esame radiografico TC RM 

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Copyright information

© Springer-Verlag Italia 2011

Authors and Affiliations

  • A. Leone
    • 1
    Email author
  • A. Costantini
    • 1
  • M. Visocchi
    • 2
  • A. Vestito
    • 1
  • P. Colelli
    • 1
  • N. Magarelli
    • 1
  • C. Colosimo
    • 1
  • L. Bonomo
    • 1
  1. 1.Dipartimento di Bioimmagini e Scienze RadiologicheUniversità Cattolica del Sacro CuoreRomaItaly
  2. 2.Dipartimento di NeurochirurgiaUniversità Cattolica del Sacro CuoreRomaItaly

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