The Journal of Bone and Joint Surgery, Vol 69, Issue 6 833-836, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
Occipitocervical fusion. Indications, technique, and long-term results in thirteen patients
SB Wertheim and HH Bohlman
Thirteen patients who underwent occipitocervical fusion that was performed
using the same operative technique were followed for an average of 3.6
years (range, two to seven years). The indications for surgery were
occipitocervical instability, neurological deficit, or intractable pain
that was not responsive to non-operative treatment. Of the thirteen
patients, eight had rheumatoid arthritis, two had atlanto-axial
osteomyelitis, and one patient each had trauma, ankylosing spondylitis, and
atlanto-occipital osteoarthritis. At follow-up, all of the thirteen
patients had a solid arthrodesis and relief of severe pain in the neck. Of
the ten patients who had had myelopathy preoperatively, all improved, but
of four patients who had been unable to walk preoperatively because of
severe motor involvement, only one was considered to be able to walk. Of
the thirteen patients, ten had a satisfactory result. Occipitocervical
arthrodesis using iliac grafts and the wiring technique that is described
herein achieves immediate stable fixation, allowing early mobilization with
a successful arthrodesis, and it should be undertaken before severe
myelopathy occurs in patients who have instability of the cervical spine.
The operation may optimize the patient's chances of neurological recovery.
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