Posterior occipitoaxial fusion for atlantoaxial dislocation associated with occipitalized atlas

Management of cervicomedullary compression in patients with congenital and acquired osseous–ligamentous pathologies

“…Today, with advances in microsurgery and diagnostic tools, we can easily reach this region and results have much improved. 2,6,8,9,12,22,30,32,34,35 However, optimal stabilization after transoral dens resection is still a controversial issue in the literature. 2,3,6,9,12,15,17,22,32,35 Neurological impairment due to instability can be prevented in most cases.…”

“…15,26,36,37 In the literature some studies report advantages of posterior decompression and fusion following anterior decompression under the same anesthesia. 6,12,35,46 Jain et al 34 emphasized that neurological improvement cannot be achieved in more than half the patients with CVJ who were treated with transoral decompression and this procedure only prevented progression of the patient's neurological status. Di Lorenzo et al 12 noted in their clinical study that, with only posterior decompression 11.5% of the patients recovered, 40% obtained less benefit from the surgery than expected and 26% did not change.…”

“…4,6,12,17,29,34,[19][20][21][22]38 After Forster's description of occipitocervical fusion (OCF) supported by fibular graft, the outcomes of many OCF procedures have been reported. 30,34,39 In our technique, after the passage of an extradural wire through a 0.5 cm hole which was drilled bilaterally to the squamo occipitalis, C0-C2 fusion was performed with an iliac graft over the decorticated occipital bone. The graft was stabilized to the occiput by both wiring and screw fixation; therefore, iliac bone was used as a load carrier and fusion material.…”

“…Successful fusion rates with this technique have been reported at 88-98%. 13,[18][19][20][21][22][23]34,37,40 In our series this technique was used in 13 cases, and our successful fusion rate was 100%. Newman and Sweetnam 26 performed the OCF technique with in situ grafting without instrumentation, and reported their fusion rates as 89%.…”

Die okzipitozervikale Fusion bei chronischer Polyarthritis

“…unbefriedigend 21 1 Th1 8 3 4 3A 3A 2 befriedigend 22 3 C2 8 0 0 3A 2 2 befriedigend 23 3 C2 9 5 3 2 1 1 befriedigend 24 1 Th1 8 3 3 2 2 1 befriedigend 25 3 C2 8 3 0 2 1 1 befriedigend 26 2 C2 10 3 0 2 2 1 befriedigend 27 1 C7 8 3 3 1 1 1 Ja unbefriedigend 28 2 C3 8 0 0 3A 1 2 befriedigend In der Literatur werden verschiedenste Techniken für eine okzipitozervikale Fusion beschrieben. Außer der simplen Anlagerung eines Knochenspans an die Hinterhauptschuppe und den Dornfortsätzen der Halswirbelsäule (sogenannte "Onlay-Technik"), die eine rigide externe Fixation benötigt (12), werden von den meisten Autoren Implantate zur internen Fixation verwendet: Dabei handelt es sich um Cerclagen (27,35,40,57), Cerclagen verstärkt mit Knochenzement (5, 18), biegsame Stäbe (14,26,41), formbare Schlingen (33) oder Platten (18,19,23,47,49). Die Verwendung von Platten und Schrauben ist technisch am schwierigsten, bietet aber die höchsten Fusionsraten (Grob et al …”