Eine neue Fixationsplatte zur dorsalen okzipitozervikalen Fusion - Indikationsstellung, OP-Technik und erste klinische Ergebnisse

Abstract

Indications for occipito-cervical fusion are destruction by tumor, rare cases of traumatic destruction and local instabilities mainly induced by rheumatoid arthritis. Some disadvantages of widely used wiring techniques are complicated occipital fixation techniques and insufficient stability in vertical direction, which demands for the additional use of polymethylmethacrylat or other techniques. We developed a new fixation plate, which avoids these disadvantages. The plate can be occipitally anchored with five AO/ASIF small fragment screws and with 0.9 diameter cerclage wires at the posterior arches of the cervical vertebra. Until now we have treated ten patients by this technique. Nine of them suffered from rheumatoid arthritis with instability C1-C2 in all cases, existing dens upward migration in one case and inflammatoric destruction of the dens axis and the atlanto-occipital joints in all other cases. One patient suffered from metastatic destruction of the second cervical vertebra. The surgical technique and indications are presented in detail. The satisfactory outcome and solid bony fusion in all cases and the absence of severe complications encourage us for the continued use of this technique for occipito-cervical fusion.