Causes and strategies of reoperation in cervico-occipital diseases
10.3760/cma.j.issn.0253-2352.2015.05.015
- VernacularTitle:枕颈部疾患再手术原因分析与对策
- Author:
Baorong HE
;
Xiaobin YANG
;
Liang YAN
;
Dingjun HAO
;
Hua GUO
;
Xiaodong WANG
- Publication Type:Journal Article
- Keywords:
Cervical atlas;
Axis;
Reoperation;
Spinal fusion
- From:
Chinese Journal of Orthopaedics
2015;35(5):565-570
- CountryChina
- Language:Chinese
-
Abstract:
Objective To summarize the causes and strategies of reoperation in cervico-occipital diseases,so as to minimize the incidence of reoperation.Methods Between January 2000 and January 2012,23 patients who underwent reoperation in our hospital because of severe complications of cervico-occipital diseases were retrospectively analyzed.There were 14 males and 9 females with the age at primary surgery range from 18-52 years.The interval between reoperation to primary surgery was 3 h-11 years.The reasons of reoperation included pseudarthrosis in 15 cases,aggravated neurological deficit in 3 cases,internal fixation failure in 2 cases,cerebrospinal fluid leakage in 1 case and tumor recurrence in 2 cases.All patients presented with continuous neck pain,numbness of the limbs or pyramidal tract signs.11 patients suffered from neurological deficit,with the average JOA score of 7.8.All patients underwent excision of posterior arch or decompression of foramen magnum,iliac bone grafting,atlantoaxial or occipital-cervical fusion.JOA score and radiograph were used to evaluate the surgical outcome during follow-up.Results The operation was completed successfully in all cases.The average surgical time was 160 min (130-310 min),and the average blood loss of 800 ml (range 300 to 2000 ml).No intraoperative vascular,nerve and spinal cord injury.There were no postoperative neurological deterioration,pharyngeal wall and intraspinal infection.Two cases of postoperative wound infection,healing by dressing change and prolong the use of antibiotics.No severe complications were noted.All patients were followed up for an average of 21 months (6 months-3 years).At the final follow-up,the JOA score was significantly better as compared with preoperation,with an average of 13.2.Based on Macnab criteria,there were 11 excellence,8 good,4middle.Bone fusion was achieved in all patients without instrumentation failure at final follow-up.Conclusion The main reasons of reoperation in cervico-occipital diseases are pseudoarthrosis and remnant symptoms,effective fusion and decompression are the key points to reduce reoperation rate in cervicooccipital operation.
