The prevention and treatment of postoperative complications after cervico-occipital fusion
- VernacularTitle:颈枕区融合术后并发症的防治
- Author:
Dingjun HAO
;
Baorong HE
;
Wei LEI
- Publication Type:Journal Article
- Keywords:
Occipital bone;
Cervical vertebrae;
Spinal fusion;
Intraoperative complications;
Postoperative complications
- From:
Chinese Journal of Orthopaedics
1999;0(07):-
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the complications after cervico-occipital fusion and to explore the methods of the prevention and treatment of complications. Methods Three hungred and eighteen patients were fused in cervico-occipital region from January 1985 to January 2003. Of them, 65 cases with postoperative complications were reviewed. The complications in perioperative period comprised vertebral artery injury during the operation, temporary injury of nerve root, leakage of cerebrospinal fluid, spinal cord injury or deterioration, infection and asphyxiation. The complications in mid- to long-term included bone graft nonunion or delayed fusion, vertebral body shifting, internal fixation implants breaking or loosening, slipping of screws and pseudojoint formation. The complications in bone graft donor region were haematoma, pain and infection. Two physicians were assigned to follow-up the patients. Results Three hungred cases were followed up from 18 months to 18 years with an average of 6 years and 8 months. There were 15 cases with complications after surgery in single fusion group, the incidence was 24.4%. 1 case deteriorated of spinal function after surgery, 2 with bone graft displacement, 1 with bone graft absorption, 1 with bone graft nonunion who recovered after reconstruction. 50 complications presented in internal fixation group, the incidence was 19.1%, Foramen magnum was decompressed in 1 case with vertebral displacement and fixed with Cervifix. Odontoid process was resected in 1 case with atlanto-axis dislocation and deterioration of spinal function through oral approach and cervico-occipital region was fused, the symptom was improved obviously after operation. Spinous process fracture was found in 1 case 3 months later post-fixation with Simmons wire, the atlanto-odontoid vertebra was fused again and fixed with Vetex, the bone graft was fused completely. The temporary injury of nerve root due to wrong directions of the screws, were adjusted during the operation. 4 patients who felt pain caused by screw, which were then extruded out. 2 cases with vertebral artery injury were ligated or bleeding ceased after screw fixation. Conclusion The key points to reduce the complications are familiarity with dissection and operative skills. Appropriate internal fixation also can reduce the complications. Pressure dressing was useful to eliminate the haematoma in bone graft donor region.
