Background: Complication rates following occipitocervical and atlanto-axial fusion are high. While methods to fuse the upper cervical spine levels have evolved, complication rates and surgical survivorship of occipitocervical fusion versus atlanto-axial fusion are incompletely understood.
Methods: The PearlDiver Research Program (www.pearldiverinc.com) was used to identify patients undergoing primary occipitocervical or atlanto-axial fusion between 2007 and 2017. Incidence of each fusion procedure was studied across time. Multivariable logistic regression was used to compare 30-day readmission, 30-day medical complications, and post-operative opioid utilization at 1, 3, 6, and 12 months between cohorts, controlling for age, gender, Charlson Comorbidity Index (CCI), and indication for surgery. Risk of revision was compared through Cox-proportional hazards modeling, Kaplan-Meier survival, and log-rank test.
Results: Cohorts of 483 occipitocervical fusions and 737 atlanto-axial fusions were examined. From 2008 to 2016, incidence of occipitocervical fusion rose 55.9%, whereas atlanto-axial fusion rose 21.6%. A greater percentage of atlanto-axial fusions were due to trauma (69.9% vs. 50.5%), whereas a greater percentage of occipitocervical fusions were due to degenerative disease (41.6% vs. 29.4%) ( = 0.0161). Total 30-day complications were seen in 40.9% of occipitocervical fusion patients compared to 26.3% of atlanto-axial fusion patients (aOR=2.06, < 0.0001). Risk of surgical site infection was increased (aOR=2.59, = 0.0075). Kaplan Meier survival analysis and Cox-proportional hazards demonstrated greater risk of revision following surgery for occipitocervical fusion (log rank: < 0.0001, aHR=2.66, 95%CI 1.73-4.10, < 0.0001).
Conclusions: Rates of occipitocervical and atlanto-axial fusion are rising, while complication and revision surgery rates remain high, with occipiticervical fusion leading to higher rates even after controlling for patient characteristics and surgical indication. Spine surgeons should be cautious when considering fusion of the occipitocervical levels if atlanto-axial fusion could be performed safely and provide adequate stabilization to treat the same pathology.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8820023 | PMC |
| http://dx.doi.org/10.1016/j.xnsj.2020.100017 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Three-dimensional kinematic analysis of the cervical spine following posterior atlantoaxial fusion under physiological loading: An in vivo study.
Clin Biomech (Bristol)
January 2025
The Orthopedic Hospital, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China. Electronic address:
Background: This study aimed to analyze the three-dimensional cervical motion characteristics in patients who underwent posterior atlantoaxial fusion surgeries using cone beam computed tomography and 3D3D registration technology.
Methods: The study selected 20 patients who underwent posterior atlantoaxial fusion surgery and 20 healthy people as the control group. All subjects underwent cone beam computed tomography scans of the occipital and cervical spine in 7 different functional positions, then 3D3D registration of Occipital-C7 was performed at each functional position to calculate the motion characteristics of each segment.
Asymptomatic iatrogenic bilateral occlusion of vertebral artery after atlantoaxial fusion: a case report.
Acta Orthop Traumatol Turc
November 2024
Department of Neurosurgery, Chonnam National University Hospital, Gwangju, Republic of Korea.
Article Synopsis
- Vertebral arterial injury (VAI) can be a serious complication after C1-C2 posterior screw fixation, as observed in a case of a 34-year-old woman with quadriplegia who suffered bilateral VAI caused by her surgical screws.
- Postoperative imaging revealed that the screws had violated the vertebral arteries but did not result in any neurological deterioration or infarction.
- The case highlights the importance of careful screw placement to prevent VAI during surgery, as well as the potential for variations in blood circulation to impact patient outcomes.
[Imaging study on determining the rationality of atlantoaxial fixation angle based on the ratio of line segments between anatomical markers on lateral X-ray films].
Zhonghua Yi Xue Za Zhi
December 2023
Department of Spinal Surgery, the Second Affiliated Hospital (Yuying Children's Hospital) of Wenzhou Medical University, Wenzhou 325027, China.
To propose a method to determine the unreasonableness of the fixed angle in posterior atlantoaxial fusion surgery based on the ratio of line segments between anatomical landmarks of the atlantoaxial joint. A cross-sectional study was conducted. According to the inclusion criteria, a screening was performed on the database of asymptomatic volunteers who had full-spine lateral X-ray films taken at the Second Affiliated Hospital of Wenzhou Medical University from May 2016 to May 2021.
View Article and Find Full Text PDFA novel technique of managing an irreducible posteriorly displaced type 2 odontoid fracture: A case report.
Surg Neurol Int
October 2023
Directorate of Medical Education and Research, Mumbai, Maharashtra, India.
Background: Type 2 odontoid fractures with posterior displacement are rare. Most acute cases reported in the literature are readily reduced with traction alone. Here, we reviewed the management of a chronic, posteriorly displaced odontoid fracture that was managed with a unique posterior reduction maneuver.
View Article and Find Full Text PDFBasilar Invagination With Chiari Type I Malformation and Atlanto-Axial Instability: A Rare Case Report.
Cureus
August 2023
Radiodiagnosis, Sri Devaraj Urs Academy of Higher Education and Research, Kolar, IND.
Basilar invagination (BI) and Chiari malformation type I (CM-I) are important anomalies involving the craniovertebral junction (CVJ) involving the skull base and occipitocervical region. The incidence of BI is rare involving < 1% of the general population worldwide. They present with varied and complex clinical-radiological features.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!