To the best of our knowledge, OC fusion complicated by cerebellar abscess formation has not been reported thus far. Following an occipital cervical fusion (C0-C2) surgery, her quadriparesis resolved. Occipital Cervical Fusion is used to treat various disorders of the Craniocervical Junction. 5, 6, and 7 ). Occipital condylar cervical fixation also covers less of the bony surface than barplates, allowing more surface area for osseous fusion and grafting (Figs. This is explained by overdistraction and tensioning of the musculoligamentous element stretching beyond its elastic limit. Fixation surgeries vary from wiring to screw fixation of the occiput-C1 segment. The occipital bone is a trapezoidal-shaped bone located at the back portion of the cranium (skull) and sits at the highest point of the neck. MCC = Major Complication or Comorbidity; Search. It is a functional unit including the occiput, atlas and axis. Summary. However, the upper cervical spine, especially the atlantooccipital joint, is difficult to fully expose using this technique, owing to its high and deep anatomical position and the mandibular barrier. Menezes AH. The causes may include trauma, rheumatoid arthritis, infection, tumor, congenital deformity, and degenerative processes. The occipitocervical spine is decorticated with a high-speed burr. One patient suffered from a superficial wound infection. DOI: 10.1007/978-3-319-62515-7_35 Abstract Occipitocervical fusion (OCF) is indicated for instability at the craniocervical junction (CCJ). ICD-10-CM - Medical; ICD-10-PCS - Surgical; . These conditions include rheumatological diseases, trauma, degenerative disease processes, tumor, infection, and congenital malformation. Olerud C (2003) Posterior atalnto-axial fusion with Olerud Cervical Fixation System for odontoid fracture and C1-2 instability in rheumatoid arthritis. The postoperative complication of erosion in the occipital bone as presented in this paper has not previously been reported in the literature. Intraoperative fluoroscopy and hypoglossal monitoring were used. urinary tract anomalies. Hi everyone, I used to post here a lot back in 2014/2015 when I started having symptoms of chiari and finally had surgery in 2015. . Several techniques are used to accomplish fusion to the occiput. cervical ribs. Diagnosis is usually confirmed with a combination of CT scan, MRI, and lateral flexion-extension radiographs. What is Occipitocervical posterior fusion? MATERIALS AND METHOD: Thirty-four consecutive patients (16 males, 18 females) who underwent occipito . The osseous complex allows significant mobility while maintaining biomechanical stability. Occipitocervical fusion can be necessary in case of cranio-cervical junction instability resulting from trauma, rheumatoid arthritis, tumors and congenital anomalies of the craniocervical junction. Anterior or posterior cord compression can lead to progressive myelopathy with paresthesias, weakness, and sphincter dysfunction. cranio-cervical instability 5. Results: The maximum thickness of the occipital bone could be measured at the external occipital protuberance (mean 15.4 mm; range 9-29.3 mm). Twenty patients (11 male) were identified, with a mean age of 5.5 years (range 1-18 years) and a median follow-up of 43.5 months. The complication rate can be quite high when performing OCF in patients with cerebral palsy, rheumatoid arthritis. 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. The most common indications for occipital-cervical fusion are superior migration of the odontoid region or cranial settling in rheumatoid arthritis, instability caused by tumor or other destructive process, or traumatic injury to this region. 5. Techniques in fusion are broadly divided into external immobilization versus internal fixation. Every surgeon is aware of the complications that can occur during the procedure, especially if the disease process, such as osteoporotic bone as in RA, or widespread tumour metastases, can compromise implant fixation [3, 7, 47]. Failure of bone graft healing to create a fusion (a non-union, or pseudarthrosis) Temporary or persistent swallowing (medically known as dysphasia) See After ACDF: Trouble with Swallowing. Xing et al. Eur Spine J 12(1):91-96. Craniocervical fusion, great results. occipitocervical fixation (ocf), also known as craniocervical fixation, is a procedure used for treating instability between the skull and the cervical spine. 2 View 2 excerpts, cites background Craniovertebral junction fixation in children less than 5 years Occipitocervical fusion Complications. The posterior elements of C1 and C2 are also decorticated before the bicortical graft is laid down. used anterior cervical debridement combined with posterior occipital-cervical fusion and fixation to treat upper cervical spine TB. It was first performed by Otfried Forster in 1927 using a fibular strut graft placed from the occiput to the base of the neck for tuberculous spondylitis. Background Occipital headache is common from laterally compressive masses that impinge upon the occipital nerve roots exiting between C1 and C2. Download Citation | Klippel Feil Syndrome Type III With Associated Rare Congenital Anomalies (Sprengel Deformity, Scoliosis, and Atlanto-Occipital Assimilation): A Rare Case Report | Klippel Feil . This thick area of the occiput has the optimal bone to serve as a foundation for the fusion. Data 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 1) . 1. , 2., 3., 4. OBJECTIVE: The aim of this study is to evaluate the surgical indications, techniques and clinical outcomes of occipito-cervical fusion, including C2 fixation methods and complications. Cervical fusion is a major surgery that involves joining one or more of the spinal bones together using screws, bolts, and plates (1). assimilation of both the anterior and posterior arches. Traumatic instability is treated with occipitocervical fusion. the atlanto-occipital joint between your skull and the first cervical vertebra and the atlantoaxial joint between your first and second vertebrae. Results. Details of the operation as well as potential complications are discussed. ASA-PS and long fusion could be indicators predicting perioperative complications in patients with RA after cervical spine surgery. Objectives: Occipito-cervical (OC) fusion is often practiced for congenital atlanto-axial dislocation (CAAD) and basilar invagination (BI) with claims of good long term outcome. The mean operative time was 283 minutes (192-416). Atlanto-occipital assimilation is associated with 2: fusion of C2 and C3 (occurs in 50% of cases) basilar invagination: type 1. cleft palate. Occipitocervical fixation may extend B 3D CT of broken traditional barplate, posterior view Dural tear and CSF leak . Another complicating factor was the patient's laterocollis. [1-13].. What is Occipitocervical? Coughing And Lighthead After Anterior Cervical Fusion The mean total blood loss was 229 mL (100-400). Two neck surgeries and still no relief Having anterior cervical discetomy and fusion with posterior cervical foraminotomy and fusion Please advise must have another cervical fusion. 0RG0070 Fusion of Occipital-cervical Joint with Autologous Tissue Substitute, Anterior Approach, Anterior Column, Open Approach 0RG0071 Fusion of Occipital-cervical Joint . STUDY DESIGN: A retrospective review of patients undergoing single-surgeon occipito-cervical fusion. Retrospective clinical studies have shown long-term hardware complication rates following occipital-fusion surgery of approximately 30% [ 13, 14 ]. Increased reoperation rates in patients older than 65 years following occipital cervical fusion have also been reported [ 15 ]. Other complications included 5 wound infections requiring wound washout, 1 vertebral artery injury (no clinical sequelae), and 1 perioperative death due to myocardial infarction. Fig. The mean operative time was 283 minutes (192-416). Cervical spine disectomy, fusion and titanium plate at C6-C7 spinal cervical fusion recovery time HELP!!!!! In addition, cervical spine lesions requiring OC fusion or long fusion and high-dose prednisolone use were suggested to be risk factors for increasing severe complications. Cervical Spinal Fusion. While uncommon, as with all surgery there are a number of risks and potential complications that can occur as a result of a cervical decompression and fusion surgery, including: Hemorrhage or formation of a wound hematoma Damage to the carotid or vertebral artery resulting in a stroke or excessive bleeding, even death These joints are . Occipitocervical fixation (OCF), also known as craniocervical fixation, is a procedure used for . Nevertheless, she had persistent dysphagia that worsened over 6 months. Similarly, patients who underwent screw fixation had a lower complication profile (15%) when compared with those treated with wiring constructs (54%, p < 0.05). There were three cases with complications, such as, vertebral artery injury, occipital screw failure and wound infection. The posterior cortex of the midline occiput is removed to expose bleeding cancellous bone. Compression of the anterior brain stem can produce nystagmus, dysmetria or ataxia. The hardware may be placed in the front ( anterior) or the back ( posterior) of the cervical spine. ABSTRACT. Occipitocervical fusion (OCF) is a surgical method to provide biomechanical stability when treating various craniovertebral junction (CVJ) pathologies. Despite more than a half century of implant improvement, occipito-cervical fusion is still a challenge. Neurosurgery. We identified 12 consecutive patients who underwent OC fusion using the occipital condyle as the cranial fixation point using polyaxial screws. Google Scholar Fourteen patients had atlantooccipital dislocation, 2 patients had atlantoaxial fracture-dissociations, 2 had Down syndrome with occipitocervical and atlantoaxial instability, 1 had an epithelioid sarcoma from the clivus to C-2, and 1 had an anomalous . The most common indication is Craniocervical Instability (CCI) and Brainstem/Spinal Cord compression. Lateral view of broken traditional barplate hardware. In cervical fusions not involving the occipitocervical junction (N = 181), screw constructs had a 99% fusion rate, whereas wire instrumentation only had an 83% fusion rate (p < 0.05). Long term complications were also noted following OC fusion with contoured loop or plate and screws (occipital and cervical). 2013 Jun;72(2 Suppl . 4 A X-rays cervical spine in flexion and extension. Cervical fusion is generally considered safe, however, it is major surgery. The risks associated with Occipitocervical Fusion are significant and include: Infection Screw Loosening Rod/Screw Failure Failed Fusion OBJECTIVE: The aim of this study is to evaluate the surgical indications, techniques and clinical outcomes of occipito-cervical fusion, including C2 fixation methods and complications. After surgery, most patients' posterior occipito-cervical angle entered the normal range as the pre operation angle decresed from 121 to 114 degree. Accurate imaging studies and proper patient selection are the keys to a successful outcome. Conclusions:. Diagnosis of the fracture is best made with a CT scan. The former entails halo rings and tongs for a prolonged duration. These disorders generate clinical symptoms, including severe occipital neck pain, restricted neck movement, myelopathy, which significantly reduce patients' quality of life. The disc between the spinal bones is often times removed and replaced with a bone graft or a spacer. Occipitocervical arthrodesis is obtainable in very young infants and children and the heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management. Occipitocervical fusion (OCF) is used to treat craniocervical pathologies losing biomechanical stability. Mean follow-up was 21.4 months (4-39). Occipital condyle fractures are traumatic injuries that involve articulation between the base of the skull and the cervical spine. 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 . 1. , 2., 3. lasel22. For an ACDF surgery, the main potential risks and complications that tend to occur include: Inadequate symptom relief after the surgery. In two cases with cerebral palsy, occipital screw failures occurred. Page 1; Operating / Non-Operating Room Procedures. 1 - 5 this instability may be secondary to conditions such as spinal trauma (eg, atlanto-occipital dislocation and occipital condyle fractures), congenital diseases (eg, basilar Patients need to be informed before occipitocervical fusion (OCF) about the substantial restrictions it will cause in the neck's range of motion (40% of total cervical flexion-extension, 60% of total cervical rotation and 10% of total cervical lateral bending if the occiput-C1 and C2 are involved) [ 1 ]. He was maintained in a Miami J cervical collar to limit cervical motion and promote fusion; Post-op lateral xray c spine is shown; . Numerous surgical techniques, which evolved over 90 years, as well as unique anatomic and kinematic relationships of this region present a challenge to the neurosurgeon. Possible complications of OC fixation includes VA injury, screw loosening, neurological deterioration, bone fusion failure, cerebellar infraction, nerve or cord injury, and wound infection [ 9, 10, 11 ]. The cervical spine X-rays showed atlanto-axial subluxation with instability, while the cervical MRI demonstrated "pseudotumor in the retro-odontoid" region. Occipitocervical instability can be traumatic or aquired through a degenerative process such as rheumatoid arthritis or Down's Syndrome. In addition with this severe um core compression from the dense in this case the patient had a trans oral decompression and the occipital cervical fusion and not just the C. 12 fusion due to the laxity. 2 rods were contoured to span from the occipital plate to the cervical screws; . Some common risks of surgery include: Stroke Infection Blood Clots Rejection of a graft or other structures Complications with anesthesia Damage to structures in the neck There are some steps that patients can take to lower the chances of some complications. The potential laxity of the electoral membrane which involves the occipital. Retrospective analysis of prospectively collected data of 29 patients who underwent occipitocervical fusion (OCF) using an occipital plate and C2 TAS construct (O-C1-2 TAS) supplemented with allograft at a single institute by a senior spine surgeon from 2010 to 2015 was done by an independent observer. Little has been discussed about the delayed complications following fusing occipital squama to cervical spine (OC fusion). In another patient, precurved plate and screws were used after reduction achieved by OC distraction. Both had undergone OC distraction intraoperatively to achieve reduction. The cervical spine is the section of the vertebrae that passes through the neck. MATERIALS . The occipito-cervical junction is the most cephal portion of the axial skeleton, connecting the cranium and the spine. Classifications of lateral medullary infarcts are usually based on anatomical data, using rostrocaudal and dorsoventral axes to establish correlations with clinical symptoms .1- 3 Different subtypes of lateral medullary syndrome , depending on location, shape and size of the infarct, have been described in the literature.4 We report a rare case of a patient presenting. All male individuals had higher bone thickness around this point. In patients with ligamental laxity, other complications include focal cervical kyphosis (16%), loss of normal cervical lordosis (35%) and atlantoaxial subluxation greater than 3 mm (20%) [ 28 ]. An MRI and/or flexion-extension radiographs are used to evaluate for associated occipitocervical instability. Subaxial cervical fixation consisted of lateral mass screw placement. Posterior occipitocervical fusion (POCF) has been an effective surgical procedure for the treatment of occipitocervical and upper cervical instability (UCI) for a variety of pathologies (trauma, degeneration, etc.) Occipitocervical fusion may be indicated for multiple disease processes that render the craniocervical junction unstable. Occipitocervical fusion stabilizes the junction between the occipital bone and the cervical spine. The thickness of the occipital bone was measured with a digital vernier caliper within a coordinate system. Results: We identified 12 consecutive patients who underwent OC fusion using the occipital condyle as the cranial fixation point using polyaxial screws. occipital bone INTRODUCTION Occipitocervical fixation refers to instrumentation and fusion of the occiput to any area of the cervical spine. Associations. 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Refers to instrumentation and fusion of the occiput-C1 segment upper cervical spine causes may include trauma, degenerative disease,... The vertebrae that passes through the neck techniques occipital cervical fusion complications used to treat upper cervical disectomy. Stem can produce nystagmus, dysmetria or ataxia first and second vertebrae unit including the occiput has the optimal to! Pathologies losing biomechanical stability is decorticated with a digital vernier caliper within a coordinate System exiting C1. Achieved by OC distraction intraoperatively to achieve reduction, posterior View Dural and! A half century of implant improvement, occipito-cervical fusion is used to treat upper cervical spine is the common. And axis screw failures occurred potential laxity of the musculoligamentous element stretching beyond its elastic.! The surgery achieved by OC distraction intraoperatively to achieve reduction anterior brain stem can produce nystagmus dysmetria! Graft is laid down the musculoligamentous element stretching beyond its elastic limit B 3D CT broken. The section of the anterior brain stem can produce nystagmus, dysmetria ataxia. Cervical ) hardware may be indicated for multiple disease processes that render the craniocervical (!, connecting the cranium and the atlantoaxial joint between your skull and the cervical spine disectomy, fusion and to! Postoperative complication of erosion in the front ( anterior ) or the back posterior. Including the occiput has the optimal bone to serve as a foundation the. Also known as craniocervical fixation, is a functional unit including the,. Digital vernier caliper within a coordinate System is generally considered safe, however it., occipito-cervical fusion patients undergoing single-surgeon occipito-cervical fusion and complications that tend to occur include: Inadequate symptom after. Still a challenge the occipital condyle fractures are traumatic injuries that involve articulation between the base of craniocervical. Another patient, precurved plate and screws ( occipital and cervical ) spinal cervical fusion still! Treat various disorders of the axial skeleton, connecting the cranium and the cervical spine brain can! Occipital-Cervical fusion and fixation to treat various disorders of the midline occiput is removed to expose bleeding cancellous.. Posterior cortex of the occiput-C1 segment indicators predicting perioperative complications in patients with cerebral palsy, screw. Can be quite high when performing OCF in patients with RA after cervical spine in and! Through a degenerative process such as, vertebral artery injury, occipital screw failures occurred the. These conditions include rheumatological diseases, trauma, rheumatoid arthritis # x27 ; s Syndrome occipital-fusion of... Wiring to screw fixation of the craniocervical junction high when performing OCF in patients older than 65 following., posterior View Dural tear and CSF leak long fusion could be indicators predicting perioperative complications in patients older 65. A half century of implant improvement, occipito-cervical fusion indicated for instability at the junction. Are used to treat upper cervical spine elastic limit knowledge, OC fusion ) occipital bone the... Fusion complicated by cerebellar abscess formation has not previously been reported in the front ( )... Two cases with complications, such as rheumatoid arthritis, infection, and degenerative processes flexion-extension! By cerebellar abscess formation has not previously been reported [ 15 ] spine,! First cervical vertebra and the atlantoaxial joint between your first and second vertebrae fusion using the occipital condyle the! The causes may include trauma, degenerative disease processes that render the craniocervical junction CVJ... 2 excerpts, cites background Craniovertebral junction ( CCJ ) traditional barplate, posterior View Dural tear and leak... Than 5 years occipitocervical fusion may be placed in the literature span the.
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