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Occipitocervical Fixation: Long-Term Results

Deutsch, Harel MD; Haid, Regis W. Jr MD; Rodts, Gerald E. Jr MD; Mummaneni, Praveen V. MD

doi: 10.1097/01.brs.0000154715.88911.ea
Cervical Spine

Study Design. The study is a retrospective review of 58 patients who underwent occipitocervical fusion between 1997 and 2001.

Objectives Our objective is to study the clinical results after occipitocervical fixation with long-term follow-up and assess factors contributing to clinical success.

Methods Data from patient charts, operative notes, physician office notes, and imaging studies were incorporated in the study. Myelopathy was assessed using a Nurick scale for preoperative and postoperative evaluation. Fusion was assessed using cervical plane films with flexion and extension views.

Results Mean follow-up was 36 months, with all patients having a greater than 1-year follow-up. The most common pathology was congenital cranial settling (41%) followed by trauma (22%) and rheumatoid arthritis (17%). Myelopathy was the most common presentation (62%) followed by pain (28%). A successful fusion occurred in 48 out of 51 patients (94%). Symptoms improved in 86% of patients, whereas 35% improved 1 Nurick grade. Complications occurred in 30% of patients. The cervical wound infection rate was 5%. The rate of adjacent level degeneration was 7%. The mortality rate was 1.7%.

Conclusions Occipitocervical instrumentation allows for very high fusion rates without the need for halo vest immobilization. All patients with successful fixation have pain resolution. Myelopathy improves in most patients, whereas one-third of patients demonstrate dramatic improvement.

This study is a retrospective review of 58 patients undergoing occipitocervical fusion with a mean 36-month follow-up. High fusion rates (94%) are possible with occipitocervical instrumentation without requiring external halo vest stabilization. Significant neurologic improvement occurred in 35% of patients.

From the Department of Neurosurgery, Emory University, Atlanta, Georgia.

Acknowledgment date: June 16, 2003. First revision date: October 14, 2003. Acceptance date: October 17, 2003.

The device(s)/drug(s) that is/are the subject of this manuscript is/are not FDA-approved for this indication and is/are not commercially available in the United States.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Harel Deutsch, MD, Assistant Professor, Department of Neurosurgery, Rush University, 1725 West Harrison Street #970, Chicago, IL 60612; E-mail:

© 2005 Lippincott Williams & Wilkins, Inc.