Abstract
Introduction
Occipitocervical fusion (OCF) is a safe and reliable method for stabilization of craniocervical instabilities caused by different mechanisms. Especially patients with acute instabilities and unaffected previous range of motion of the cervical spine, may be affected by the fusion procedure. The purpose of this study was to evaluate retrospectively surgical outcome and patient disability after OCF procedure for acute instabilities.
Methods
Over a 5-year period, 2009–2014, 33 consecutive patients from one academic trauma center were retrospectively identified as having been treated with OCF. Of these, 29 patients were diagnosed with traumatic or pathologic fractures or nonunion after previously failed surgical intervention. Average follow up was 25 months (range 4–55 months). Demographics were assessed. Fixation constructs were delineated. Nonunion, infection, implant failure, neurologic disabilities, and deaths were used as complication variables. Patient disability was addressed by the Neck Disability Index (NDI) and persistent pain (VAS).
Results
Traumatic and pathologic fractures were the main reason (90%) for an OCF procedure in our study population. Three patients (10%) suffered from a persistent instability after previously failed surgical stabilization. Fracture location was the odontoid process of C2 in 69% of the patients and 31% had a combined injury to C1 and C2. Fusion was performed between the occiput and C4 in 55%, C5 in 28%, and C3 in 17%. Fusion was enhanced by autologous bone in 14 patients (48%). 3 patients (10%) underwent a surgical revision due to screw misplacement (1) and infection (2). Related to the advanced patient age, 15 patients died before the evaluation. One patient died during hospital stay related to his preoperatively existing comorbidities. Fourteen patients were evaluated. Average age was 74.2 years (range 18–95 years). Regarding the clinical outcome, pain averaged 2.5 on the VAS (median 2). 64% of the patients reported no or minimal pain (VAS 0–2), 23% complained of mild pain (VAS 2–4). The NDI averaged 42% (range 16 – 80%).
Conclusion
OCF is a reliable and safe procedure for the treatment of craniocervical instabilities caused by different injuries and diseases. Overall, pain reduction was effective. Patients reported no or only mild pain (VAS 0–4) in 86% during our evaluation. Functional disability averaged 42% utilizing the NDI, which is rated as “medium disability.” The rate of 52% deceased patients reflects the fact that OCF is performed in our institution especially in elderly and patients with increased rates of comorbidities.