POSTERIOR OCCIPITOCERVICAL FUSION - INDICATIONS AND RESULTS

Study design: This report will relate to our experience with the occip itocervical fusion with the y-plate, which we used in the treatment of 53 patients. Methods: 39 of the patients had rheumatoid arthritis. Ot her indications demanding surgery were posttraumatic conditions, degen erative and congenital lesions, osteomyelitis, tumor and psoriasis art hritis. Before surgery, all patients suffered from pain in the neck an d/or in the back of the head. On a linear scale from 0 to 10, the pain was rated as 8,0 in average (range 4 to 10). 33 patients had an insta bility of the atlantoaxial region and 26 patients a basilar invaginati on of the odontoid. A cervical myelopathy was found in 23 cases. One s urgeon fused the occiput to C2 in 30 cases, to C3-C5 in 14 cases and t o C7-T2 in 9 cases. In 17 patients a resection of the odontoid had to be performed before fusion to adaequately decompress the spinal cord. Results: 31 of the patients could be controlled with a follow-up of at average 45,9 months. 16 patients had died. At the time of follow-up, the pain was rated as 2,1 in average (range 0 to 8). The myelopathy cl eared up in all cases but 3. 9 patients required further operations on the cervical spine. 5 patients developed an instability at the level( s) below the fusion and an enlargement of the fusion to these levels h ad been performed. The fusion rate was 98,1%. The results were satiesf ying in 25 (80,6%) and not satiesfying in 5 patients (19,4%). Conclusi ons: These results show the effectivness of the occipitocervical fusio n with the y-plate in a wide range of applications. It offers advantag es above other techniques.