The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis

Abstract

Purpose: Disorders in occipitocervical region are difficult to treat. Complications often occur after fusion surgery and may be life-threatening in severe cases. This study is to investigate the causes and treatment strategies for the postoperative complications of occipitocervical fusion.

Methods: Between May 1985 and May 2011, 316 patients with various occipitocervical diseases underwent occipitocervical surgery, with or without internal fixation. Two physicians were assigned for patients follow-up. Their medical records and radiographs were reviewed and the postoperative complications, including those at the occipitocervical region and donor site, were analyzed.

Results: Three hundred cases were followed up from 24 months to 26 years with an average of 9 years and 8 months, and the follow-up rate was 94.9%. There were 16 cases with complications after surgery in the uninstrumented fusion group; the incidence was 33.3%. These included 11 patients (22.9%) with complications in occipitocervical region and five patients (11.9%) with donor-site complications. 45 complications presented in the instrumented fusion group, the incidence was 17.9%. These included 30 patients (11.9%) with complications in occipitocervical region and 15 patients (5.9%) with donor-site complications. Perioperative complications included vertebral artery injury, spinal cord injury, nerve root injury, suffocation, cerebrospinal fluid leakage, and infection. Mid- to long-term complications included bone-graft displacement or absorption, aggravated vertebral dislocation, improper screw placement, spinous process fracture, and internal fixation breakage. Donor-site complications were hematoma, pain and infection.

Conclusion: The surgery of occipitocervical fusion carries a relative high risk for complications, especially if no instrumentation is used. The key points in reducing complications are the surgeon's familiarity with the anatomy of occipitocervical region and the appropriate internal fixation.