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. 2022 Mar;164(3):903-911.
doi: 10.1007/s00701-021-05039-z. Epub 2021 Nov 25.

Safety analysis and complications of condylar screws in a single-surgeon series of 250 occipitocervical fusions

Sharon Ka Po Tam  1 , Paolo A Bolognese  2 , Roger W Kula  3 , Andrew Brodbelt  4 , Mansoor Foroughi  1 , Marat Avshalumov  5 , Denmark Mugutso  5 , Ilene Ruhoy  6
Affiliations

Safety analysis and complications of condylar screws in a single-surgeon series of 250 occipitocervical fusions

Sharon Ka Po Tam et al. Acta Neurochir (Wien). 2022 Mar.

Abstract

Objective: Condylar screw fixation is a rescue technique and an alternative to the conventional configuration of occipitocervical fusion. Condylar screws are utilized when previous surgical bone removal along the supraocciput has occurred which makes anchoring of a traditional barplate technically difficult or impossible. However, the challenging dissection of C0-1 necessary for condylar screw fixation and the concerns about possible complications have, thus far, prevented the acquisition of large surgical series utilizing occipital condylar screws. In the largest case series to date, this paper aims to evaluate the safety profile and complications of condylar screw fixation for occipitocervical fusion.

Methods: A retrospective safety and complication-based analysis of occipitocervical fusion via condylar screws fixation was performed.

Results: A total of 250 patients underwent occipitocervical fusions using 500 condylar screws between September 2012 and September 2018. No condylar screw pullouts, or vertebral artery impingements were observed in this series. The sacrifice of condylar veins during the dissection at C0-1 did not cause any venous stroke. Hypotrophic condyles were found in 36.4% (91 of the 250) cases and did not prevent the insertion of condylar screws. Two transient hypoglossal deficits occurred at the beginning of this surgical series and were followed by recovery a few months later. Corrective strategies were effective in preventing further hypoglossal injuries.

Conclusions: This surgical series suggests that the use of condylar screws fixation is a relatively safe and reliable option for OC fusion in both adult and pediatric patients. Methodical dissection of anatomical landmarks, intraoperative imaging, and neurophysiologic monitoring allowed the safe execution of the largest series of condylar screws reported to date. Separate contributions will follow in the future to provide details about the long-term clinical outcome of this series.

Keywords: Cranial vertebral fixation; Occipital condyle; Occipital condyle screw; Occipitocervical fusion.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Sectional anatomy of occipital condyle
Fig. 2
Fig. 2
A–C Orthogonal 2D reconstructions (A sagittal, B axial, C coronal)
Fig. 3
Fig. 3
3D reconstruction of a C0-2 construct with condylar screws
Fig. 4
Fig. 4
A X-rays cervical spine in flexion and extension. Lateral view of broken traditional barplate hardware. B 3D CT of broken traditional barplate, posterior view
Fig. 5
Fig. 5
A Intraoperative photo of C0-2 construct with condylar screws, in a case with concurrent C1-sparing Chiari decompression, prior to the insertion of the bars. B Intraoperative photo of C0-2 construct with condylar screws, in a case with concurrent Chiari decompression, with C1 lamiectomy, after the insertion of the bars
Fig. 6
Fig. 6
A Sagittal 2D CT showing condylar screw in hypoplastic condyle. B Sagittal 2D CT with C0-2 construct with condylar screws and extremely thin supraocciput
Fig. 7
Fig. 7
Sagittal 2D CT with C0-2 construct with condylar screws and mature fusion
See this image and copyright information in PMC

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