Functional outcome of plate fusions for disorders of the occipitocervical junction

Twenty-eight patients with average followup of 27 months (range, 12-51 mont hs) required occipitocervical fusion with plates. A 1992 to 1996 consecutiv e case series enrolled patients prospectively from two institutions. Five s urgeons participated. Sixteen patients had inflammatory arthritis; four, os teogenesis imperfecta; three, tumors; three, congenital anomalies; one, pse udarthrosis after odontoid fracture; and one, osteoarthritis. Twenty-two of 28 (78.6%) patients had serious comorbid medical conditions. Additional ha lo immobilization of 6 weeks was used in 16 of 27 patients. Four patients r equired revision surgery. No patients showed a decline in neurologic status and average neurologic improvement was one Nurick grade. Two-year followup showed 13 (50%) excellent, nine (34.6%) good, two (7.7%) fair, and two (7. 7%) poor outcomes based on a functional outcome scale. There were three dea ths during the follow up period (overall mortality rate of 10.7%). One deat h was attributable to airway obstruction, one death 14 months postoperative ly was attributable to late Methicillin resistant Staphylococcus aureus sep sis at the bone graft donor site, and one death 41 months postoperatively w as attributable to a stroke. The overall fusion rate was 85.2% (23 of 27 pa tients), with a 96.3% (26 of 27 patients) occipitocervical fusion rate. Thr ee patients had a possible asymptomatic end segment pseudarthrosis with scr ew loosening. Twenty-two of 26 (84.6%) interviewed patients would choose th e surgery again if given the choice.