Occipitocervical Fusions Research Articles

Hyperthermia during occipito-cervical fusion with acrylic cement. Epidural thermometry in 23 cases.

In 22 patients, 23 posterior occipito-cervical fusions using acrylic cement were studied; 18 had seropositive rheumatoid arthritis and 4 traumatic atlanto-axial instability. The mean age was 60 (39-75) years. During the curing of the cement, epidural temperature measurements were performed over the cerebellum and between the foramen magnum and C1. Temperatures up to 69 degrees C were recorded. Cooling with profuse surface irrigation using normal saline solution or precooled 8 degrees C fluid did not influence the maximal temperatures recorded under the cement. Even though no gross neurological damage was noted, the epidural temperatures in occipito-cervical fusion with acrylic cement can be of sufficient degree to be hazardous; surface irrigation does not seem to be an effective way to reduce this risk.

Spine fusion for atlanto-axial instability

A follow-up study was done on fifty-seven spine fusions for atlanto-axial instability, classified as Type I - deficient odontoid (twenty-eight patients), Type II - deficient ligaments (twenty-three patients), and Type III - rotatory fixation (six patients). The average age of the patients at the time of the fusion was thirty years, and half had had significant trauma. Symptoms had been present for an average of 12.3 months before fusion. Preoperatively pain was the predominant complaint in twenty-nine; neurological complaints, in twenty-four; and instability in the rest. Of the forty-six Gallie fusions, there was one non-union and of the eleven occipitocervical fusions, two non-unions. Follow-up averaging 4.2 years revealed resolution of symptoms in almost all patients.

Atlanto-Axial Fusion in Rheumatoid ArthritisA New Method of Fixation with Wire and Bone Cement

Twenty-eight occipito-cervical fusions performed over the past 4 years in patients with rheumatoid arthritis are discussed. All of the patients with one exception had signs of neurological involvement preoperatively due to pressure on occipital nerve roots, spinal cord and/or vertebral arteries. A surgical technique using wire, pin and bone cement and permitting early mobilization without external fixation was used and is described in detail. The clinical results were excellent in 21 cases with an additional five patients showing improvement. One patient did not benefit from surgery and one had no symptoms preoperatively. The results are encouraging and the possibility of early mobilization (the day after surgery) is of the utmost importance for this group of patients.