C1–C2 Fusion Versus Occipito-Cervical Fusion for High Cervical Fractures: A Multi-Institutional Database Analysis and Review of the Literature

Bhimani, Abhiraj D.; Chiu, Ryan G.; Esfahani, Darian R.; Patel, Anish H.; Denyer, Steven; Hobbs, Jonathan G.; Mehta, Ankit I.

doi:10.1016/j.wneu.2018.07.182

Cited by 14 publications

(19 citation statements)

References 23 publications

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“…The rate of return to the OR after occipitocervical fusion was 9.1%, which can increase up to 14.9% in patients over 65 years old [11] . Interestingly, Bhimani et al also found a higher rate of 30-day sepsis (4.6%) after occipitocervical fusion with approaching significance ( p = 0.0699) [2] . Similarly, in the present study 4.8% of occipitocervical fusion patients developed sepsis.…”

Section: Discussionmentioning

confidence: 93%

“…These findings in addition to higher rates of surgical site infection (OR = 2.49) following occipitocervical fusion may highlight the impact of longer incisions extending into the hair line, more instrumentation, and longer operative time on outcomes [12][13][14] . Bhimani et al found that occipitocervical fusions were on average a half an hour longer with patient length of stay one day more than atlanto-axial fusions [2] . A study of 49 patients undergoing occipitocervical fusion highlighted deep and superficial infection, implant loosing, and hardware prominence as among the most common complications [12] .…”

Section: Discussionmentioning

confidence: 99%

“…Despite the perceived difficulties of atlanto-axial fusion difficulties, several retrospective reviews have suggested increased complications such as non-union, neuralgia, sepsis, and return to OR following occipitocervical compared to altanto-axial fusion with no difference in functional outcomes as measured by Neck Disability Index [5][6][7] . However, occipitocervical fusion has yet to be compared to atlanto-axial fusion in a matched analysis [8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

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Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion

Yang

Patel

DiSilvestro

et al. 2020

North American Spine Society Journal (NASSJ)

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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%) (p = 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, p < 0.0001). Risk of surgical site infection was increased (aOR = 2.59, p = 0.0075). Kaplan Meier survival analysis and Cox-proportional hazards demonstrated greater risk of revision following surgery for occipitocervical fusion (log rank: p < 0.0001, aHR = 2.66, 95%CI 1.73-4.10, p < 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.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion

Yang

Patel

DiSilvestro

et al. 2020

North American Spine Society Journal (NASSJ)

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“…This finding is in line with that of other studies reporting that the C2 spine was the most commonly involved vertebrae ( McMordie et al, 2020 , Menger et al, 2020 ). This may be explained by the fact that cervical spine fractures are mainly due to improper movements such as hyper flexion, hyperextension, and rotational movements ( Modi et al, 2016 ) of the C2 spine, which has been reported to account for 50% of the rotational movements due to the loose articular capsules ( Bhimani et al, 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Cervical Spine Injuries and Maxillofacial Trauma: A Systematic Review

AlQahtani

Alotaibi

Jaber

et al. 2021

The Saudi Dental Journal

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Objectives Identify specific maxillofacial trauma patterns associated with cervical spine injuries. Methods The protocol was developed according to (PRISMA-P) and was admitted to PROSPERO under accreditation code #CRD42020177816. Furthermore, the reporting of the present SR was conducted based on the PRISMA checklist. Results Of the 1,407,750 patients recorded, a total of 115,997 patients (12.13%) had MFF with an associated CSI with a gender proportion (M:F) of 3.63:1 respectively. Motor vehicle accident was the most common cause of the combined Maxillofacial Trauma (MFT) and CSI. The most common CSI location was at the C2, followed by the C5 cervical spines. The most common location of a maxillofacial fracture resulting in a CSI was the mandible. Conclusion The incidence of the association of CSIs with MFT has been low (12.13%). Nevertheless, in cases of an isolated mandibular trauma due to a severe blow presenting with a low Glasgow Coma Scale, maxillofacial surgeons should be at a high alert of an associated CSI.

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“…There are some postoperative disadvantages of OC fixation, such as reduced cervical mobility, difficulty in swallowing, postoperative neck stiffness, etc. [4][5][6][7][8]. 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].…”

Section: Introductionmentioning

confidence: 99%

Occipitocervical fusion complicated with cerebellar abscess: a case report

Lee

Liu

2020

BMC Musculoskelet Disord

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Background: Occipitocervical (OC) fusion is indicated for OC instability and other conditions. Surgical complications include infection, malunion, and instrument failure. Case presentation: We described a patient who underwent OC fusion and subsequently developed complication of cerebellar abscess and obstructive hydrocephalus. A 63-year-old male patient had been suffering from long-term neck pain and limb numbness and weakness. Cervical spine examination revealed tight stenosis at C1 level and instability in the C1-C2 joints. A C1 laminectomy with OC fusion was performed, and the patient was discharged. Unfortunately, a few days later, he went to the emergency department and complained of persistent dizziness, vomiting, and unsteady gait. Computed tomography (CT) and magnetic resonance imaging (MRI) images revealed a suspicious cerebellar abscess formation and hydrocephalus. Furthermore, CT images indicated that the left screw was loose, and the diameter of the right screw hole was much larger than the size of the screw. Besides, inappropriate length of the screw penetrated the occipital bone and may cause the disruption of dura mater. The patient underwent external ventricular drainage first, followed by abscess drainage and C1-C2 fixation a few days later. He was discharged without any further neurological deficits or infectious problems. The patient recovered with intact consciousness, full muscle strength, and improved numbness throughout the extremities, with a Nurick grade of 1. A follow-up magnetic resonance imaging at 3 months after surgery revealed near total resolution of the abscess. Inform consent was obtained from this patient. Conclusions: Carefully conducting the procedure using the most tailored approach is essential to successful surgery, but this rare complication should always be kept in mind.

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C1–C2 Fusion Versus Occipito-Cervical Fusion for High Cervical Fractures: A Multi-Institutional Database Analysis and Review of the Literature

Cited by 14 publications

References 23 publications

Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion

Postoperative complication rates and hazards-model survival analysis of revision surgery following occipitocervical and atlanto-axial fusion

Cervical Spine Injuries and Maxillofacial Trauma: A Systematic Review

Occipitocervical fusion complicated with cerebellar abscess: a case report

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