A Review of Complications Associated With Craniocervical Fusion Surgery

Neurosurgery ◽  
2010 ◽  
Vol 67 (5) ◽  
pp. 1396-1403 ◽  
Author(s):  
Rishi Lall ◽  
Nirav J Patel ◽  
Daniel K Resnick
Keyword(s):  
Vertebral Artery ◽  
Human Subjects ◽  
Perioperative Complications ◽  
Case Series ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
Atlantoaxial Fusion ◽  
Management Of Complications ◽  
Upper Cervical ◽  
Craniocervical Fusion

Abstract BACKGROUND: Fusion at the craniovertebral junction is performed to treat instability of the upper cervical spine and occiput. The literature consists exclusively of case series in which complication rate and avoidance are variably addressed. OBJECTIVE: To describe the rates of various complications encountered during craniocervical fusions and discuss preoperative and perioperative strategies useful for risk reduction. METHODS: A computerized search of PubMed for literature on craniocervical fusion and other upper cervical fusions was performed. Keywords used in the search included: occipitocervical fusion, odontoid screw, atlantoaxial fusion, with and without complications, anterior fixation, lateral mass screw, transarticular screw, halo, vertebral artery injury, and odontoid fracture. References were limited to studies on human subjects. Other sources were identified from the reference lists of relevant publications. RESULTS: Twenty-two reports described data derived from 2274 procedures analyzed for complications. The most commonly encountered perioperative complications were related to instrumentation failure after nonunion with rates as high as 7% during occipitocervical fusion and 6.7% during atlantoaxial fusion. Other commonly encountered complications included injury to the vertebral artery (1.3%-4.1% during placement of C1-C2 transarticular screws, most commonly in the case of high-riding vertebral artery), dural tears, and wound infection. CONCLUSION: Occipitocervical or atlantoaxial fusion procedures can be performed with low morbidity. Safety is enhanced with appropriate preoperative assessment of anatomic variants and preparation for perioperative management of complications.

scholarly journals Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion?

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Katharina E. Wenning ◽  
Martin F. Hoffmann
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Range Of Motion ◽  
Rating Scale ◽  
Neck Disability Index ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
Atlantoaxial Fusion ◽  
Upper Cervical

Abstract Background The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods Over a 5-year period (2010–2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities (p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients (p = 0.01). Conclusion Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome.

Short-term effects of an upper cervical spine traction-manipulation program in patients with cervicogenic dizziness: A case series study

2020 ◽  
Vol 33 (6) ◽  
pp. 961-967
Author(s):  
Andoni Carrasco-Uribarren ◽  
Jacobo Rodríguez-Sanz ◽  
Miguel Malo-Urriés ◽  
César Hidalgo-García ◽  
José Miguel Tricás-Moreno ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Case Series ◽  
Upper Cervical Spine ◽  
Cervical Pain ◽  
Case Series Study ◽  
Spine Mobility ◽  
Upper Cervical ◽  
Cervical Spine Manipulation ◽  
Cervicogenic Dizziness ◽  
Series Study

BACKGROUND: Damage on the somatosensory system could cause sensation of dizziness, a condition known as cervicogenic dizziness (CD). Manual physical therapy has shown beneficial effects, relieving the symptoms of cervicogenic dizziness. However, the effect of upper cervical spine manipulation is unknown, as this is a technique that respects the International Federation of Orthopedic Manipulative Physical Therapists (IFOMPT) safety criteria. OBJECTIVE: To assess the effects of upper cervical spine traction-manipulation in subjects with cervicogenic dizziness. METHODS: This was a descriptive case series study. Treatment focused on the upper cervical spine manipulation procedure. Evaluation was performed before and after the treatment. Variables recorded include upper and lower cervical range of motion, Cervical Flexion-Rotation Test (CFRT), dizziness intensity and cervical pain (VAS), self-perceived dizziness measured with Dizziness Handicap Inventory (DHI) and subjective perception of outcome (GROC-scale). RESULTS: Ten subjects were recruited. After the treatment protocol, there was an increased range of movement towards the most restricted side, as measured by the CFRT (p< 0.001), decreased intensity of dizziness (p< 0.001) and intensity of pain (p< 0.001). Functional capacity also improved after the intervention (p< 0.011). CONCLUSION: Upper cervical spine manipulation may decrease dizziness intensity and cervical pain and improve functional ability and upper cervical spine mobility in patients with cervicogenic dizziness.

scholarly journals STABILIZATION OF OCCIPITOATLANTOAXIAL COMPLEX THROUGH POSTERIOR APPROACH

2005 ◽  
pp. 008-015
Author(s):  
Nikolay Alekseyevich Korzh ◽  
Aleksandr Evgenyevich Barysh
Keyword(s):  
Cervical Spine ◽  
Posterior Approach ◽  
Clinical Effectiveness ◽  
Upper Cervical Spine ◽  
Fixation Device ◽  
Occipitocervical Fusion ◽  
Cervical Spine Injuries ◽  
Spine Injuries ◽  
Upper Cervical

A posterior occipitocervical fusion with a novel fixation device developed at Sytenko Institute for Spine and Joints Pathology and a technology of its application have been biomechanically substantiated. The analysis of surgeries in 6 patients with upper cervical spine injuries and disorders was performed. The results were assessed as excellent in 3 patients and good in 3 ones. Some criteria for comprehensive estimation of clinical effectiveness of surgeries performed were proposed.

Anatomical Variations of the Vertebral Artery in the Upper Cervical Spine

2018 ◽  
Vol 43 (4) ◽  
pp. 367-371 ◽  
Author(s):  
Maria Francisca Elgueta ◽  
Johanna Ortiz Jimenez ◽  
Nina Nan Wang ◽  
Almudena Pérez Lara ◽  
Jeffrey Chankowsky ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Anatomical Variations ◽  
Upper Cervical Spine ◽  
Upper Cervical

scholarly journals Tumoral Calcinosis of the Cervical Spine Associated with a Pathologic Odontoid Fracture

2022 ◽  
Vol 2022 ◽  
pp. 1-6
Author(s):  
Andy Y. Wang ◽  
Joseph N. Tingen ◽  
Eric J. Mahoney ◽  
Ron I. Riesenburger
Keyword(s):  
Cervical Spine ◽  
Soft Tissues ◽  
Odontoid Fracture ◽  
Tumoral Calcinosis ◽  
Upper Cervical Spine ◽  
Occipitocervical Fusion ◽  
First Case ◽  
Pathologic Fractures ◽  
Upper Cervical ◽  
Calcium Deposits

Tumoral calcinosis involves focal calcium deposits in the soft tissues surrounding a joint and most commonly occurs in the hips and elbows, rarely in the cervical spine. Furthermore, it has not been known to be associated with pathologic fractures. To the best of our knowledge, our case report highlights the first case of a pathologic type II odontoid fracture associated with adjacent tumoral calcinosis, resulting in pain, dysphagia, and severe spinal stenosis. The patient underwent a posterior occipitocervical fusion and C1 laminectomy, along with planned tracheostomy and gastrostomy to avoid expected difficulty with postoperative extubation and dysphagia. Additionally, we present a review of existing literature on tumoral calcinosis in the upper cervical spine.

scholarly journals Study on Course for Vertebral Artery in Upper Cervical Spine.

2000 ◽  
Vol 49 (3) ◽  
pp. 975-977
Author(s):  
Atsushi Inoue ◽  
Hiroaki Konishi ◽  
Shinichiro Hara ◽  
Ryoichi Takasuga ◽  
Hironori Hara ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Upper Cervical Spine ◽  
Upper Cervical

scholarly journals Effect of occipitocervical fusion with screw-rod system for upper cervical spine tumor

BMC Surgery ◽  
2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Jun Zou ◽  
Chenxi Yuan ◽  
Ruofu Zhu ◽  
Zhiming Zhang ◽  
Weimin Jiang ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Upper Cervical Spine ◽  
Spine Tumor ◽  
Occipitocervical Fusion ◽  
Rod System ◽  
Upper Cervical ◽  
Cervical Spine Tumor

scholarly journals CT-Guided Percutaneous Vertebroplasty of the Upper Cervical Spine Via a Translateral Approach

2012 ◽  
Vol 5;15 (5;9) ◽  
pp. E733-E741
Author(s):  
Zheng-Yin Liao
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Percutaneous Vertebroplasty ◽  
Upper Cervical Spine ◽  
Ct Guided ◽  
Safety And Efficacy ◽  
Carotid Sheath ◽  
Metastatic Lesions ◽  
Upper Cervical ◽  
Postoperative Time

Background: The clinical management of spinal hemangiomas and osteolytic metastases involving the upper cervical spine (C1-C3) is challenging. Symptoms vary from simple vertebral pain to progressive neurological deficits. Surgery and radiotherapy have been the treatment options for years. Surgery, however, can result in complications, such as hemorrhage, and may be counter-indicated when the treatment goal is primarily palliative due to multiple metastases, an unfavorable prognosis and/or a poor performance state. On the other hand, radiotherapy carries the risk of inducing secondary sarcomas or producing radionecrosis. Percutaneous vertebroplasty (PVP) was recently introduced as an alternative for treating patients in whom surgery and radiotherapy are counter-indicated. As of yet, there are few PVP case reports. Objective: This study aimed to evaluate the safety and efficacy of PVP using a computed tomography (CT)-guided translateral approach via the space between the carotid sheath and vertebral artery for hemangiomas or metastatic lesions at C1-C3 under local anesthesia. Study Design: CT-guided PVP was performed in 15 patients with hemangiomas or metastatic lesions at C1-C3 and clinical outcomes were evaluated. Setting: An interventional therapy group at a medical center in a major Chinese city. Methods: Fifteen consecutive patients had a total of 15 cervical vertebral bodies treated with CT-guided PVP via a translateral approach. The patients were followed up for a mean postoperative period of 8.3 months (range, 1-40 months). Pain status was assessed using a visual analog scale (VAS). The presence of complications was assessed preoperatively (baseline) and at 24 hours, 2 weeks, and one, 3, 6, 12 and 24 months postoperatively, or until the patient died or was lost to follow-up. Results: Fifteen consecutive patients were successfully treated with CT-guided PVP via a translateral approach. Their mean VAS score decreased from 7.7 ± 2.9 preoperatively to 1.4 ± 1.5 by the 24 hour postoperative time point, and was 1.2 ± 1.3 at 2 weeks, 1.2 ± 1.3 at one month, 1.4 ± 1.3 at 3 months, 0.6 ± 0.9 at 6 months, 0.3 ± 0.5 at 12 months, and 0 at 24 months after the procedure. The mean VAS score at all of the postoperative time points differed significantly from the preoperative baseline score (P < 0.05). No severe complications were observed. Mild complications included 2 cases (13.3%) of asymptomatic cement leakage into the epidural space, one case (6.67%) of anterior leakage from the vertebral body, and 2 cases (13.3%) of paravertebral leakage. Limitations: This was an observational study with a relatively small sample size. Conclusions: The safety and efficacy of CT-guided PVP using a translateral approach via the space between the carotid sheath and vertebral artery were demonstrated in patients with hemangioma or metastasis in the upper cervical spine. CT-guided PVP via a translateral approach should become a treatment option for such patients. Key words: CT-guided percutaneous vertebroplasty, upper cervical spine, translateral approach, hemangioma, osteolytic metastasis, pain

Fracture of a sublaminar stainless steel cable in the upper cervical spine with neurological injury

1994 ◽  
Vol 81 (6) ◽  
pp. 932-933 ◽  
Author(s):  
J. Bob Blacklock
Keyword(s):  
Stainless Steel ◽  
Cervical Spine ◽  
Spinal Canal ◽  
Neurological Injury ◽  
Upper Cervical Spine ◽  
Steel Cable ◽  
Content Type ◽  
Atlantoaxial Fusion ◽  
Upper Cervical ◽  
Fine Print

✓ Sublaminar cables have been used to stabilize bone grafts for arthrodesis in the cervical spine in recent years. Previous accounts of their use have indicated no instances of breakage or neurological injury. This report is of a delayed cable fracture that resulted in penetration of the dura with neurological injury in a patient who had undergone atlantoaxial fusion for rheumatoid subluxation. The cable fracture occurred in the epidural space beneath the attempted arthrodesis and resulted in uncoiling of the cable, which penetrated the spinal canal and caused a one-sided sensory deficit.

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