Dorsal Fusion as Correction of Craniocervical and Atlantoaxial Instability in Patients with Benign and Malignant Lesions using O-Arm System

Abstract

Introduction A retrospective and prospective analysis of the surgical treatment and results of 99 patients with benign and malignant craniocervical, atlantoaxial and high cervical lesions operated during 36 – month period (2011–2014) at the Department of Neurosurgery, Klinikum Fulda gAG, Germany was performed. The aim of the analysis was to assess the factors affecting dorsal fusion as correction of craniocervical and high cervical instability. Material and Methods The mean age of the patients was 57 years. The female to male ratio was 1:1,3. The most frequent neurological symptoms were quadriparesis, discoordination, cranial and spinal nerves palsy and local pain. We analyzed 67 patients with traumatic lesions, 10 patients with inflammatory lesions, 8 patients with degenerative instability, and 14 patients with high cervical tumors. In the subgroup of patients with traumatic lesions we found 39 odontoid fracture II Type, 11 Hangemann fracture and 17 combined cervical fracture; in the subgroup of patients with tumors we observed 3 cases with plasmocytoma, 3 case with chordoma, 1 case with C2–3 schwanoma, and 7 cases with metastatic lesions; in the inflammatory subgroup we analyzed 6 cases with RA and 4 cases ankylose spondylitis. Results In 99 patients we performed 129 operations. We used posterior cervical, and craniocervical median approach. Because of craniocervical/cervical instability we made posterior screw fixation in all of 99 patients. In 47 patients we performed additionally decompressive laminectomy. To improve screw placement accuracy we performed intraoperative O-Arm in 82 cases. The operative duration was 2.25 hour. in O-Arm operations and 4.35 hour in C-arm operation. The most common operative complications were: CSF leak – in 2 cases, postoperative infection – in 4 cases, and without early operative mortality. The 12-monts follow-up showed good recovery in 65 patients, moderate disabling – 25 patients, severe disabling – 5 patients, vegetative state – 4 patients, death 3 patients with malignant lesions. Conclusion Early correction of craniocervical and high cervical instability facilitated neurological recovery by preserving the existent neurological function. Using of O-Arm increase operative screw placement accuracy, and preserve intraoperative nerve and vertebral artery injury. Recently because of the improvement of neuroimaging techniques, operative approaches, surgical techniques and neurointensive care the results of treatment of these lesions are optimal.