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Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up

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Abstract

Purpose

Occipitocervical fusion is necessary for many pathologies of the craniocervical junction. The anatomy of the region is unique, and fusion can cause significant morbidity. This retrospective review aims to investigate the complication rates and outcomes of occipitocervical fixation.

Material and methods

This is a retrospective review of 128 patients with occipitocervical fixation operated between 1994 and 2020. The average follow-up is 63 months.

Results

The indications of occipitocervical fixation were basilar invagination (53 patients; 41.4%), trauma (25 patients; 19.5%), tumor (23 patients; 18%), instability due to rheumatoid arthritis (13 patients; 10.2%), cervical deformity (7 patients; 5.5%) and os odontoideum (7 patients; 5.5%). There were six early postoperative (1st month) deaths.

We observed complications in 67 patients (52%). Most common complication was implant-related (32%), followed by wound problems (23.4%), systemic and other complications (11.7%), neurologic complications (6.2%).

Implants are removed in 31 patients (24%) for different reasons: deep wound infection (7), local pain and restriction of head movements (21), respiratory distress and swallowing problems (2), screw fracture and local pain (1).

Conclusions

Occipitocervical fixation has quite large number of complications and significantly restricts head movements. With the advent of our biomechanical concepts, indications should be limited, and shorter cervical fixations should be preferred.

Level of evidence

Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding.

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Data availability

Yes.

References

  1. Deutsch H, Haid RW Jr, Rodts GE Jr, Mummaneni PV (2005) Occipitocervical fixation: long-term results. Spine (Phila Pa 1976) 30(5):530–535. https://doi.org/10.1097/01.brs.0000154715.88911.ea

    Article  Google Scholar 

  2. Lu DC, Roeser AC, Mummaneni VP, Mummaneni PV (2010) Nuances of occipitocervical fixation. Neurosurgery. https://doi.org/10.1227/01.NEU.0000365744.54102.B9

    Article  PubMed  Google Scholar 

  3. Nockels RP, Shaffrey CI, Kanter AS, Azeem S, York JE (2007) Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients. J Neurosurg Spine 7(2):117–123. https://doi.org/10.3171/SPI-07/08/117

    Article  PubMed  Google Scholar 

  4. Zileli M, Çağlı S (2002) Combined anterior and posterior approach for managing basilar invagination associated with type I Chiari malformation. J Spinal Disord Tech 15:284–289. https://doi.org/10.1097/00024720-200208000-00004

    Article  PubMed  Google Scholar 

  5. Goel A (2004) Treatment of basilar invagination by atlantoaxial joint distraction and direct lateral mass fixation. J Neurosurg Spine 1:281–286. https://doi.org/10.3171/spi.2004.1.3.0281

    Article  PubMed  Google Scholar 

  6. Goel A (2010) Occipitocervical fixation: is it necessary? J Neurosurg Spine 13(1):1–2. https://doi.org/10.3171/2009.10.SPINE09761

    Article  PubMed  Google Scholar 

  7. Ashafai NS, Visocchi M, Wąsik N (2019) Occipitocervical fusion: an updated review. Acta Neurochir Suppl 125:247–252. https://doi.org/10.1007/978-3-319-62515-7_35

    Article  PubMed  Google Scholar 

  8. Elia M, Mazzara JT, Fielding JW (1992) Onlay technique for occipitocervical fusion. Clin Orthop Relat Res 280:170–174

    Article  Google Scholar 

  9. Martinez-Del-Campo E, Turner JD, Kalb S et al (2016) Occipitocervical fixation: a single surgeon’s experience with 120 patients. Neurosurgery. https://doi.org/10.1227/NEU.0000000000001340

    Article  PubMed  Google Scholar 

  10. Winegar CD, Lawrence JP, Friel BC et al (2010) A systematic review of occipital cervical fusion: techniques and outcomes. J Neurosurg Spine 13(1):5–16. https://doi.org/10.3171/2010.3.SPINE08143

    Article  PubMed  Google Scholar 

  11. Bagley CA, Witham TF, Pindrik JA et al (2009) Assuring optimal physiologic craniocervical alignment and avoidance of swallowing-related complications after occipitocervical fusion by preoperative halo vest placement. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e318168be6f

    Article  PubMed  Google Scholar 

  12. Visocchi M, Mattogno PP, Signorelli F, Zhong J, Iacopino G, Barbagallo G (2017) Complications in craniovertebral junction instrumentation: hardware removal can be associated with long-lasting stability. Personal Exp Acta Neurochir Suppl 124:187–194. https://doi.org/10.1007/978-3-319-39546-3_29

    Article  Google Scholar 

  13. Cohen LL, Yang BW, Glotzbecker MP et al (2020) Occipital plate fixation in the pediatric population. J Pediatr Orthop. https://doi.org/10.1097/BPO.0000000000001564

    Article  PubMed  Google Scholar 

  14. Crostelli M, Mariani M, Mazza O et al (2009) Cervical fixation in the pediatric patient: our experience. Eur Spine J 18:20–28. https://doi.org/10.1007/s00586-009-0980-2

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hedequist D (2015) Modern instrumentation of the pediatric occiput and upper cervical spine. HSS J 11:9–14. https://doi.org/10.1007/s11420-014-9398-4

    Article  PubMed  Google Scholar 

  16. Geck MJ, Truumees E, Hawthorne D et al (2014) Feasibility of rigid upper cervical instrumentation in children: tomographic analysis of children aged 2–6. J Spinal Disord Tech 27:110–117. https://doi.org/10.1097/BSD.0b013e318291ce46

    Article  Google Scholar 

  17. He B, Yan L, Xu Z, Chang Z, Hao D (2014) The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis. Eur Spine J. https://doi.org/10.1007/s00586-014-3354-3

    Article  PubMed  Google Scholar 

  18. Stone JG, Panczykowski DM, Tempel ZJ et al (2015) Evaluation of occipitocervical arthrodesis rates with screw-based fixation and osteoinductive fusion adjuncts. J Neurol Surg A Cent Eur Neurosurg. https://doi.org/10.1055/s-0035-1547359

    Article  PubMed  Google Scholar 

  19. Garrido BJ, Myo GK, Sasso RC (2011) Rigid versus nonrigid occipitocervical fusion: a clinical comparison of short-term outcomes. J Spinal Disord Tech. https://doi.org/10.1097/BSD.0b013e3181cc90f2

    Article  PubMed  Google Scholar 

  20. Zou X, Ouyang B, Yang H, Wang B, Ge S, Chen Y, Ni L, Zhang S, Xia H, Yang J, Ma X (2020) Surgical treatment for basilar invagination with irreducible atlantoaxial dislocation: transoral atlantoaxial reduction plate fixation vs occipitocervical fixation. BMC Musculoskelet Disord 21(1):825

    Article  Google Scholar 

  21. Wenning KE, Hoffmann MF (2020) Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? J Orthop Surg Res. https://doi.org/10.1186/s13018-019-1525-y

    Article  PubMed  PubMed Central  Google Scholar 

  22. Theologis AA, Deviren V, Tay B (2017) Temporary fusionless posterior occipitocervical fixation for a proximal junctional type II odontoid fracture after previous C2-pelvis fusion: case report, description of a new surgical technique, and review of the literature. Eur Spine J. https://doi.org/10.1007/s00586-017-5093-8

    Article  PubMed  Google Scholar 

  23. Guo Q, Deng Y, Wang J et al (2016) Comparison of clinical outcomes of posterior C1–C2 temporary fixation without fusion and C1–C2 fusion for fresh odontoid fractures. Neurosurgery 78:77–83. https://doi.org/10.1227/NEU.0000000000001006

    Article  PubMed  Google Scholar 

  24. Han B, Li F, Chen G et al (2015) Motion preservation in type II odontoid fractures using temporary pedicle screw fixation: a preliminary study. Eur Spine J 24:686–693. https://doi.org/10.1007/s00586-014-3693-0

    Article  PubMed  Google Scholar 

  25. Yang JJ, Park S, Yoon JY, Mun JW (2020) Temporary bridge occipitocervical fixation for comminuted atlantoaxial fracture. World Neurosurg. https://doi.org/10.1016/j.wneu.2020.04.122

    Article  PubMed  PubMed Central  Google Scholar 

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Author notes

  1. Nevhis Akıntürk

    Present address: Ege University Neurosurgery Department, Bornova, Izmir, Turkey

Authors and Affiliations

  1. Ege University Neurosurgery Department, Bornova, Izmir, Turkey

    Mehmet Zileli

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  1. Mehmet Zileli
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  2. Nevhis Akıntürk
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Contributions

MZ was involved in conceptualization and original draft preparation. MZ and NA had contributed to methodology, formal analysis and investigation, and writing, reviewing and editing.

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Correspondence to Mehmet Zileli.

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Cite this article

Zileli, M., Akıntürk, N. Complications of occipitocervical fixation: retrospective review of 128 patients with 5-year mean follow-up. Eur Spine J 31, 311–326 (2022). https://doi.org/10.1007/s00586-021-07037-2

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  • DOI: https://doi.org/10.1007/s00586-021-07037-2

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