Posterior occipitoaxial fusion for atlantoaxial dislocation associated with occipitalized atlas

1996 ◽  
Vol 84 (4) ◽  
pp. 559-564 ◽  
Author(s):  
Vijendra K. Jain ◽  
Piyush Mittal ◽  
Deepu Banerji ◽  
Sanjay Behari ◽  
Rajesh Acharya ◽  
...  
Keyword(s):  
Fusion Rate ◽  
Foramen Magnum ◽  
Atlantoaxial Dislocation ◽  
Posterior Fusion ◽  
Posterior Arch ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Transoral Odontoidectomy ◽  
Preoperative Status

✓ Between 1989 and 1994, 50 patients suffering from congenital atlantoaxial dislocation with either an assimilated atlas or a thin or deficient posterior arch of the atlas were treated with occipitocervical fusion using the technique described by Jain and colleagues in 1993 with a few modifications. An artificial bridge created from the occipital bone along the margin of the foramen magnum was fused to the axis using sublaminar wiring and interposed strut and lateral onlay bone grafts. Ten patients (20%) also underwent atlantoaxial lateral joint fusion by intraarticular instillation of bone chips. In 22 patients (44%) with irreducible dislocation, posterior fusion was preceded by transoral odontoidectomy. In seven patients (14%) with ventral compression, who showed marked clinical improvement on traction despite radiological evidence of persisting atlantoaxial dislocation, occipitocervical fusion was performed without ventral decompression. Seven patients (14%) underwent a single-stage transoral odontoidectomy and posterior fusion. There was no perioperative mortality and the osseous fusion rate was 88%. Of the 43 patients available at follow-up examination (range 3–12 months), 31 patients (72.09%) improved, seven (16.28%) remained the same, and five (11.6%) deteriorated in comparison with their preoperative status. Hence, this technique achieves a stable occipitocervical arthrodesis without supplemental external orthoses and facilitates early postoperative mobilization.

Forestier disease associated with a retroodontoid mass causing cervicomedullary compression

2002 ◽  
Vol 96 (2) ◽  
pp. 190-196 ◽  
Author(s):  
Naresh P. Patel ◽  
Neill M. Wright ◽  
William W. Choi ◽  
Duncan Q. McBride ◽  
J. Patrick Johnson
Keyword(s):  
Cervical Spine ◽  
Neurological Symptoms ◽  
Posterior Fusion ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Neurological Improvement ◽  
Forestier Disease ◽  
Subaxial Cervical Spine ◽  
Fine Print

Object. Forestier Disease (FD) is a progressive skeletal disorder affecting predominantly older men. It is also known as diffuse idiopathic skeletal hyperostosis (DISH) and is characterized by massive anterior longitudinal ligament calcification that forms a bridge on the anterior border of the thoracic and subaxial cervical spine. To the authors' knowledge, retroodontoid masses associated with FD have not been described. Methods. Five patients with FD and multilevel subaxial cervical fusion were treated for retroodontoid masses and cervicomedullary junction (CMJ) compression. There were four men and one woman (mean age 73 years, range 54–86 years). All patients suffered progressive neurological symptoms resulting from anterior compression of the CMJ. Four patients underwent combined transoral resection of the ligamentous mass followed by an occipitocervical fusion procedure. One patient with circumferential CMJ compression underwent a posterior decompression and occipitocervical fusion. Histopathological examination of the mass showed hypertrophic degenerative fibrocartilage. Early postoperative neurological improvement was noted in all patients. The follow-up period ranged from 4 to 19 months. At the end of the follow-up period, four patients experienced neurological improvement. One patient died 3 weeks postsurgery of pulmonary complications. Conclusions. The osseous elements of the occipitoatlantoaxial complex are not directly affected by FD. The ligamentous structures of the odontoid process, however, are exposed to significantly altered biomechanics resulting from fusion of the subaxial cervical spine associated with FD. Stress-induced compensatory ligamentous hypertrophic changes at the craniovertebral junction cause CMJ compression and subsequent neurological deterioration. This previously undescribed entity should be considered in patients with FD or DISH who present with progressive quadriparesis. Transoral decompression and posterior fusion are often needed in patients with large masses and severe progressive neurological deficits. Selected patients with smaller masses and milder neurological symptoms may be treated with posterior fusion alone.

Syrinx shunt to posterior fossa cisterns (syringocisternostomy) for bypassing obstructions of upper cervical theca

1992 ◽  
Vol 77 (6) ◽  
pp. 871-874 ◽  
Author(s):  
Thomas H. Milhorat ◽  
Walter D. Johnson ◽  
John I. Miller
Keyword(s):  
Posterior Fossa ◽  
Symptomatic Improvement ◽  
Foramen Magnum ◽  
Content Type ◽  
Results Of Treatment ◽  
Spinal Subarachnoid Space ◽  
Upper Cervical ◽  
Spinal Arachnoiditis ◽  
Chiari I

✓ Syrinx shunts to the spinal subarachnoid space are likely to fail if the cerebrospinal fluid pathways rostral to the syrinx are blocked. To bypass obstructions at or below the level of the foramen magnum, a technique was developed for shunting the syrinx to the posterior fossa cisterns, termed “syringocisternostomy.” Syrinxes were shunted to the cisterna magna in two patients with spinal arachnoiditis and to the cerebellopontine angle cistern in four patients with Chiari I malformations. There was symptomatic improvement and collapse of the syrinx in each case, with no complications or recurrences over a follow-up interval of 14 to 27 months (average 20.3 months). The surgical technique and results of treatment are described.

Radiographic and clinical follow-up review of Caspar plates in 49 patients

1996 ◽  
Vol 84 (6) ◽  
pp. 957-961 ◽  
Author(s):  
Christopher G. Paramore ◽  
Curtis A. Dickman ◽  
Volker K. H. Sonntag
Keyword(s):  
The Elderly ◽  
Fusion Rate ◽  
Neurological Deficits ◽  
Repeat Surgery ◽  
Content Type ◽  
Hardware Failure ◽  
Plate Length ◽  
Number Of Patients ◽  
Plate Failure

✓ Although they are excellent clinical tools, Caspar anterior cervical plates have not been studied closely with regard to their mechanisms of failure. As more extensive operations are contemplated on older, sicker patients, it is imperative to know when a plating system might be prone to failure and what the mechanism of that failure might be. Therefore, the authors reviewed 49 patients undergoing Caspar plate placement in whom sufficient radiographs were obtained to determine if the fate of the hardware was related to the patient's age, type of operation, and the length of construct. Eleven of 49 patients suffered hardware failure, defined as any amount of screw backout or breakage, plate pullout, or pseudarthrosis. Four patients underwent hardware removal; one underwent posterior fusion for pseudarthrosis. Only two required treatment in a halo brace. There was an eventual fusion rate of 100%, including one fibrous union, and one of the patients who underwent repeat surgery was lost to follow-up review. No graft extrusions or new neurological deficits were incurred as a result of hardware failure. Plate length predicted plate failure in a statistically significant manner. Increasing age and reoperation correlated with plate failure but were not statistically significant in this small number of patients. Telescoping of the bone graft and vertebral bodies, with concomitant migration of the plate and slippage of the screws, was common. However, telescoping was more profound in the group in which the plates failed. The authors conclude that Caspar plate failures are more likely to occur in the elderly and in patients who need longer constructs. Bone fusion can be expected even when the hardware loosens.

Anterior atlas fracture following suboccipital decompression for Chiari I malformation

2004 ◽  
Vol 1 (1) ◽  
pp. 137-140 ◽  
Author(s):  
Brian A. O'Shaughnessy ◽  
Sean A. Salehi ◽  
Saad Ali ◽  
John C. Liu
Keyword(s):  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Posterior Arch ◽  
Cervical Pain ◽  
Content Type ◽  
Suboccipital Craniectomy ◽  
Increased Risk ◽  
Downward Displacement ◽  
Chiari I ◽  
Suboccipital Decompression

✓ Chiari I malformation, a congenital disorder involving downward displacement of the cerebellar tonsils through the foramen magnum, is often treated surgically by performing suboccipital craniectomy and C-1 laminectomy. The authors report two cases in which fracture of the anterior atlantal arch occurred during the postoperative period following Chiari I decompression and C-1 laminectomy causing significant neck pain. The findings indicate that interruption of the integrity of the posterior arch of C-1, iatrogenically or otherwise, confers increased risk of anterior arch fracture. A C-1 fracture should therefore be considered in the differential diagnosis of posterior cervical pain in patients who have previously undergone decompression for Chiari I malformation.

Symptomatic C1–2 fusion failure due to a fracture of the lateral C-1 posterior arch in a patient with rheumatoid arthritis

2001 ◽  
Vol 94 (1) ◽  
pp. 137-139 ◽  
Author(s):  
Robert D. Ecker ◽  
Mark B. Dekutoski ◽  
Michael J. Ebersold
Keyword(s):  
Rheumatoid Arthritis ◽  
Neurological Recovery ◽  
Posterior Arch ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Fine Print

✓ The authors report a case in which the lateral C-1 arch fractured in a patient with rheumatoid arthritis and an intact fusion mass; this patient had previously undergone a C1–2 Brooks-type fusion. This unique complication occurred secondary to continued resorption of the C1–2 rheumatoid pannus. Two years after occipitocervical fusion the patient has made a complete neurological recovery.

Foramen magnum tumors

1978 ◽  
Vol 49 (6) ◽  
pp. 828-838 ◽  
Author(s):  
Shozo Yasuoka ◽  
Haruo Okazaki ◽  
Jasper R. Daube ◽  
Collin S. MacCarty
Keyword(s):  
Cervical Spondylosis ◽  
Clinical Presentation ◽  
Functional Results ◽  
Normal Pressure ◽  
Foramen Magnum ◽  
Neurological Deficits ◽  
Intramedullary Tumor ◽  
Content Type ◽  
Tunnel Syndrome

✓ This study involved 57 patients with benign extramedullary tumors of the foramen magnum (19 neurinomas, 37 meningiomas, and one teratoma), who were operated on between 1957 and 1976. The 37 meningiomas represented 3.2% of 1139 meningiomas of the neuraxis. The initial neurological examinations of about half of these patients were unremarkable. The clinical presentation of tumors of the foramen magnum frequently mimics multiple sclerosis, cervical spondylosis, intramedullary tumor, syrinx, carpal tunnel syndrome, and even normal-pressure hydrocephalus. All operations were performed through a posterior approach, and two surgical deaths (3.5%) were recorded. No surgery for recurrence of tumor was recorded. The follow-up review of 56 patients (98.2%) showed good functional results if the tumor was detected before severe neurological deficits occurred. The possible mechanism of the sensory symptoms and muscle atrophy of the hands is discussed, and the electromyographic findings are reviewed.

Extreme lateral—transatlas approach for resection of the dens of the axis

2002 ◽  
Vol 96 (1) ◽  
pp. 73-82 ◽  
Author(s):  
Uğur Türe ◽  
M. Necmettin Pamir
Keyword(s):  
Craniovertebral Junction ◽  
Basilar Invagination ◽  
Clinical Experiences ◽  
Occipitocervical Fusion ◽  
Content Type ◽  
Advantages And Disadvantages ◽  
Alternative Approach ◽  
Craniocervical Instability ◽  
Fine Print

Object. Various approaches have been described for resection of the dens of the axis, each of which has potential advantages and disadvantages. Anterior approaches such as the transoral route or its modifications are the most commonly used for resection of this structure. The transcondylar approach, however, which allows the surgeon to view the craniovertebral junction (CVJ) from a lateral perspective, has been introduced by Al-Mefty, et al., as an alternative approach. In this report, the authors describe the surgical technique of the extreme lateral—transatlas approach and their clinical experiences. Methods. The authors first examined the surgical approach to the dens from a lateral perspective in five cadaveric heads. They found that removal of the lateral mass of the atlas provided adequate exposure for resection of the dens. Following this cadaveric study, the extreme lateral—transatlas approach was successfully performed at the authors' institution over a 1-year period (September 1998–August 1999) in five patients with basilar invagination due to congenital anomaly of the CVJ and rheumatoid arthritis. Furthermore, during the same procedure, unilateral occipitocervical fusion was performed following resection of the dens. In all cases complete resection of the dens was achieved using the extreme—lateral transatlas approach. This procedure provides a sterile operative field and the ability to perform occipitocervical fusion immediately following the resection. No postoperative complications or craniocervical instability were observed. The mean follow-up period was 17.2 months (range 13–24 months). Conclusions. The extreme lateral—transatlas approach for resection of the dens was found to be safe and effective. Knowledge of the anatomy of this region, especially of the V3 segment of the vertebral artery, is essential for the success of this procedure.

Complications of occipital screw placement for occipitocervical fusion in children

2012 ◽  
Vol 9 (6) ◽  
pp. 586-593 ◽  
Author(s):  
Steven W. Hwang ◽  
Loyola V. Gressot ◽  
Joshua J. Chern ◽  
Katherine Relyea ◽  
Andrew Jea
Keyword(s):  
Wound Infection ◽  
Fusion Rate ◽  
Occipital Bone ◽  
Screw Placement ◽  
Occipitocervical Fusion ◽  
Pediatric Age Group ◽  
Csf Leakage ◽  
Posterior Arthrodesis ◽  
Fixation Points

Object Occipitocervical stabilization in the pediatric age group remains a challenge because of the regional anatomy, poor occipital bone purchase, and, in some instances, significant thinning of the occipital bone. Multiple bicortical fixation points to the occipital bone may be required to increase construct rigidity. The authors evaluated the complications of bicortical occipital screw placement in children with occipital fusion constructs. Methods The records of 20 consecutive pediatric patients who had undergone occipitocervical fusion between September 1, 2007, and November 30, 2010, at Texas Children's Hospital were reviewed. Results The patients consisted of 10 girls and 10 boys, ranging in age from 10 months to 16 years (mean ± SD, 7.7 ± 5.1 years). Two patients were lost to follow-up, 2 died for reasons unrelated to the surgery, and the remaining patients had at least 3 months of follow-up (mean 14 ± 11.8 months) with evaluation via dynamic radiography and CT. Four patients experienced 8 complications: 2 CSF leaks, 2 vigorous venous bleedings, worsening of quadriparesis, wound infection, radiographic pseudarthrosis, and transient dysphagia. Among 114 screws, there were 2 cases of intraoperative dural venous sinus injury and 2 cases of intraoperative CSF leakage, without clinical sequelae from these complications. Only 1 case of radiographic pseudarthrosis was identified in a patient with skeletal dysplasia and a prior failed C1–2 posterior arthrodesis. There were no difficulties with wound healing because of prominent occipital instrumentation, and there was only 1 wound infection. Conclusions Data in this report confirm that including bicortical occipital screw placement in occipitocervical constructs in children may result in a high fusion rate but at the cost of a notable complication rate.

Halifax interlaminar clamp for posterior cervical fusion: a long-term follow-up review

1993 ◽  
Vol 78 (5) ◽  
pp. 702-708 ◽  
Author(s):  
E. Francois Aldrich ◽  
Peter B. Weber ◽  
Wayne N. Crow
Keyword(s):  
Fusion Rate ◽  
Cervical Fusion ◽  
Content Type ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Cause Of Failure ◽  
Posterior Cervical Fusion ◽  
Lost To Follow Up

✓ Fifty consecutive patients requiring posterior cervical fusion for various pathologies were treated with Halifax interlaminar clamps for internal spinal fixation. Fusion involved the C1–2 level in 17 cases, the C1–3 level in one, and the lower cervical area (C2–7) in 32. No patient was lost to follow-up review, which varied from 6 to 40 months (average 21 months). Fusion failed in five patients, three at the C1–2 level, one at the C1–3 level, and one at the C2–3 level. Screw loosening was the cause of failure in four patients, and in one the arch of C-1 fractured. No other complications occurred. Because of the lack of complications, avoidance of the hazards of sublaminar instrumentation, and an excellent fusion rate, this technique is highly recommended for posterior cervical fusion in the lower cervical spine. Atlantoaxial arthrodesis was achieved in only 14 (82%) of 17 patients, however, which might be due to the higher mobility at this multiaxial level. Improved results in this region may be possible by using a new modified interlaminar clamp, by performing adequate bone fusions, and by postoperative external halo immobilization in high-risk patients.

Fusion rate: a time-to-event phenomenon

2004 ◽  
Vol 1 (1) ◽  
pp. 47-51 ◽  
Author(s):  
Sagun K. Tuli ◽  
Jayshree Tuli ◽  
Peng Chen ◽  
Eric J. Woodard
Keyword(s):  
Median Time ◽  
Fusion Rate ◽  
Smoking History ◽  
Time To Event ◽  
Female Ratio ◽  
Content Type ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Fine Print

Object. The term “fusion rate” is generally denoted in the literature as the percentage of patients with successful fusion over a specific range of follow up. Because the time to fusion is a time-to-event phenomenon a more accurate method of representation may be made using the Kaplan—Meier method of estimation. Methods. The current study was performed to illustrate that fusion rate is more accurately represented by median times as calculated using survival analysis. Patients undergoing a cervical decompressive corpectomy and reconstruction formed the basis of the primary analysis. A secondary analysis was made to evaluate the difference in the fusion times for one- compared with multilevel corpectomy cases. Data were collected at a tertiary care institution over a 5-year period with 6-month follow up after the last recruitment. Descriptive statistics of baseline patient characteristics, the extent of disease, and the surgical intervention were obtained. Fusion was the final outcome, and it was defined as the “event.” The presence of any trabeculae bridging between the vertebral body and allograft signified the occurrence of an event. Postoperative static radiographs were evaluated by independent neuroradiologists to assess the presence of fusion. Fusion rate was determined using the Kaplan—Meier estimate. The median time to fusion was calculated, as were the 95% confidence intervals (CIs). These were stratified for patients who underwent one- and two-level vertebrectomy. The log-rank test was used to differentiate between one-level and multilevel corpectomy. Multivariate analysis was performed using Cox regression for further evaluation, by adjusting for covariates (age, sex, smoking history). Fifty-seven patients underwent single- or multilevel corpectomy and fusion. The male/female ratio was similar, with a median age of 53 years. Fourteen patients had a history of cigarette smoking. Thirty-six patients underwent a one-level corpectomy, 20 a two-level corpectomy, and one patient underwent a three-level corpectomy. The analysis was restricted to one- and two-level cases. The median time to fusion for the cephalad and caudad aspect of the graft—host interface was 88 days (95% CI 82–94 days) and 85 days (95% CI 77–93 days), respectively. As generally reported in the literature, this translates to a 92% (by 2.1 years) and 93% (by 1.5 years) fusion rate, for the cephalad and caudad, respectively. The median time to fusion for the cephalad aspect of the graft for one-level vertebrectomy was 87 days (95% CI 83–91 days), whereas for two-level vertebrectomy was 90 days (95% CI 59–121 days). The median time to fusion for the caudal aspect of the graft—host interface was 85 days (95% CI 80–90 days) for one-level corpectomy and 90 days (95% CI 83–97 days) for the two-level cases. There was no statistically significant difference in the median time to fusion for one- and two-level corpectomy at either the superior or inferior aspect of the graft (p = 0.19 and 0.84, respectively). This held true even after adjusting for covariates. Conclusions. Fusion rate is a time-to-event phenomenon and is more accurately represented using the Kaplan—Meier method of estimation.

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