MAY 2020 | The Surgical Technologist | 209 RESEARCH ART I CLE Open Access Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? Katharina E. Wenning * and Martin F. Hoffmann Abstract Background: The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at least one segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment whereas occipitocervical fusion (OCF) additionally interferes with the C0/C1 segment. The purpose of our study was to investigate clinical outcome of patients that underwent OCF or AAF for upper cervical spine injuries. Methods: Over a 5-year period (2010 – 2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the Neck Disability Index (NDI) were used to evaluate postoperative neck pain and health restrictions. Demographics, follow-up, and clinical outcome parameters were evaluated. Infection, hematoma, screw malpositioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results: Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was performed in 44 patients (45.8%), and 52 patients (54.2%) were treated with AAF. Patients with OCF were diagnosed with more comorbidities ( p = 0.01). Follow-up was shorter in the OCF group compared to the AAF group (6.3 months and 14.3 months; p = 0.01). No differences were found related to infection (OCF 4.5%; AAF 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). Regarding bother and disability, no differences were discovered utilizing the NDI score (AAF 21.4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients ( p = 0.01). Conclusion: Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The current study did not show any significant differences regarding clinical outcome measured by the NDI compared to OCF. No differences were found regarding complication and infection rates in both groups. Both techniques provide a stable treatment with comparable clinical outcome. Keywords: Occipitocervical fusion, Atlantoaxial fusion, Magerl-Gallie, Cervical spine, Injury, Outcome Background The craniocervical junction represents a complex ana- tomical region consisting of two essential joints, the atlanto-occipital joint and the atlantoaxial joint [1]. Mo- bility of the cervical spine is complex and requires a combination of individual vertebral motion segments. The normal range of motion of the cervical spine contains six possible directions with the C0 to C2 region being the keystone for range of motion in the upper cer- vical spine. The atlantoaxial joint mostly accounts for ro- tation in the cervical spine. The rotational range of motion of a well-functioning C1/C2 segment was re- ported to be 23 to 39° [2], whereas rotation of the occi- put on the atlas does not exist effectively due to the depth of the atlantal sockets. Its primary directions of motion are flexion and extension. The C0/C1 segment contributes 23 to 25° of flexion/extension of the skull, © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 Internationa l License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Common s license, and indicate if changes were made. The Creative Commo ns Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. * Correspondence:
[email protected] Department of General and Trauma Surgery, BG University Hospital Bergmannsheil Bochum, Buerkle de la Camp-Platz 1, 44789 Bochum, Germany (2020) 15:8 https://doi.org/10.1186/s13018-019-1525-y © The Author(s). 2020 Open Access This article is dis tributed under the terms of the Crea tive Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, di tri ution , and reproduction in any medium, provided you give appropriate credit to the original auth or(s) and the source, provide a link to the C reative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Open Access oaxial fusion result in ome compared to on? ann tone for range of motion in the upper cervical spine. Posterior t one segment. Atlantoaxial fusion (AAF) only inhibits any motion in fusion (OCF) additionally interferes with the C0/C1 segment. clinical outcome of patients that underwent OCF or AAF for upper consecutive patients with upper cervical spine disorders ere ted with OCF or AAF. The Numeric Pain Rating Scale (NPRS) and the uate postoperative neck pain and health restrictions. Demographics, were evaluated. Infection, hematoma, screw malpositioning, and deaths up was at least 6 months postoperatively. e = 54) underwent stabilization of the upper cervical spine. OCF was ents (54.2%) were treated with AAF. Patients with OCF were diagnosed was shorter in the OCF group compared to the AAF group (6.3 nces were found related to infection (OCF 4.5%; AAF 7.7%) and . Regarding bother and disability, no differences were discovered %; p > 0.05). A reduction of disability measured by the NDI was ts ( p = 0.01). ter range of motion by preserving the C0/C1 motion segment id not show any significant differences regarding clinical outcome differences were found arding complication and inf ction rates in e treatment with comparable clinical outcome. al fusion, Magerl-Gallie, Cervical spine, Injury, Outcome mplex ana- joints, the nt [1]. Mo- requires a segments. vical spine contains six possible directions with the C0 to C2 region being the keystone for range of motion in the upper cer- vical spine. The atlantoaxial joint mostly accounts for ro- tation in the cervica spine. The rotational range of motion of a well-functioning C1/C2 segment was re- port d to be 23 to 39° [2], whereas rotation of the occi- put on the atlas does not exist effe ctivel y due to the depth of the atlantal sockets. Its primary directions of motion are flexion and exten sion. The C0/C1 segment contributes 23 to 25° of flexion/extension of the skull, pen Access This article is distributed under the terms of the Creative Commons Attribution 4.0 p://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and dium, provided you give appropriate credit to the original author(s) and the source, provide a link to cense, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver .org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. pital chum, and Research RESEARCH ART I CLE Open Access Does isolated atlantoaxial fusion result in better clinical outcome compared to occipitocervical fusion? Katharina E. Wenning * and Martin F. Hoffmann Abstract Background: The C0 to C2 region is the keystone for range of motion in the upper cervical spine. Posterior procedures usually include a fusion of at l ast segment. Atlantoaxial fusion (AAF) only inhibits any motion in the C1/C2 segment wher as occipit cervic l fusion (OCF) addi io ally nterferes with the C0/C1 segment. T purpo of our study was to investigate clinical outcome of p tients that underwent OCF or AAF for upper cervical spine injurie . Methods: Over a 5-year period (2010 – 2015), consecutive patients with upper cervical spine disorders were retrospectively identified as having been treated with OCF or AAF. The Numeric Pain Rati g Scale (NPRS) and the Neck Disabilit Index (NDI) were used to ev luate postoperative neck pain and he lth restrictions. Demographics, follow-up, and clinical outcom paramet rs wer evaluat d. Infection, hem toma, screw malp sitioning, and deaths were used as complication variables. Follow-up was at least 6 months postoperatively. Results: Ninety-six patients (male = 42, female = 54) underwent stabilization of the upper cervical spine. OCF was p rformed in 44 patients (45.8%), and 52 p ti nts (54.2%) re treated with AAF. Patients with OCF w re diagnosed with ore comorbiditie p = 0.01). Follow-up was shorter in the OCF group comp red o the AAF group (6.3 months and 14.3 months; . 1 . No difference were found related t infection (OCF 4.5%; 7.7%) and revision rate (OCF 13.6%; AAF 17.3%; p > 0.05). R garding bother nd disability, no differences were discovered util zing the NDI score (A F 2 .4%; OCF 37.4%; p > 0.05). A reduction of disability measured by the NDI was observed with greater follow-up for all patients ( p = .01). Conclusion: Theoretically, AAF provides greater range of motion by preserving the C0/C1 motion segment resulting in less disability. The cu rent study did not sh w any significant differenc s regarding clinical outcome measured by the NDI compared to OCF. No differences ere fou d regar ing complication and i fection rates in both groups. Both techniques provide a stable treatm nt with comparable clinical outcome. Keywords: Occipitocervical fusion, Atlantoaxial fusion, Magerl-Gallie, Cervical spine, Injury, Outcome Background The c anioc r ical junction represents a complex ana- tomi al region co sisting of two es ential joints, the atlanto-occipital j int a d the atlantoaxial joint [1]. Mo- bi ity of the cervical spine is complex and requires a combination of individual vertebral motion segm nts. The ormal range of motion of the cervical spine contains six possible directions with the C0 to C2 region being the keystone for ange of motion in the upper cer- vical spine. The atlantoaxial j int mostly accounts for ro tation the cervical spine. The rotational range f motion of a w ll-functioning C1/C2 segment was re- p r ed t be 23 to 39° [2], whereas rotation of the occi ut on the atlas does not exist effectively due t the depth of the atlantal sockets. I s primary directions of mo ion are flexio and extension. The C0/C1 segment contributes 23 t 25° of fl xion/extension of th skull, © The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. * Correspondence:
[email protected] Department of Ge neral and Trauma Surgery, BG Universit y Hospital Bergmannsh il Bochum, Buerkle de la Camp-Platz 1, 44789 Bochum, Germany https://doi.org/10.1186/s13018-019-1525-y