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Neurol India. 2007 Oct-Dec;55(4):363-8.

Occipitocervical contoured rod stabilization: does it still have a role amidst the modern stabilization techniques?

Author information

1
Department of Neurosurgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, India.

Abstract

BACKGROUND:

The occipitocervical contoured rod (CR) stabilization for use in craniovertebral junction (CVJ) pathologies is an effective and economical technique of posterior fusion (PF).

AIMS:

The various indications for CR in CVJ pathologies are discussed.

SETTINGS AND DESIGN:

Retrospective analysis.

MATERIALS AND METHODS:

Fifty-four patients (mean age: 31.02+/-13.44 years; male: female ratio=5.75:1) who underwent CR stabilization are included. The majority had congenital atlantoaxial dislocation (AAD; n=50); two had CVJ tuberculosis; one each had rheumatoid arthritis and C2-3 listhesis, respectively. The indications for CR fusion in congenital AAD were associated Chiari 1 malformation (C1M) (n=29); occipitalized C1 arch and/or malformed or deficient C1 or C2 posterior elements (n=9); hypermobile AAD (n=2); and, rotatory AAD (n=3). Contoured rod as a revision procedure was also performed in seven patients. Most patients were in poor grade (18 in Grade III [partial dependence for daily needs] and 15 in Grade IV [total dependence]); 15 patients were in Grade II [independent except for minor deficits] and six in Grade I [no weakness except hyperreflexia or neck pain].

RESULTS:

Twenty-four patients improved, 18 stabilized and six deteriorated at a mean follow-up (FU) of 17.78+/-19.75 (2-84) months. Six patients were lost to FU. In 37 patients with a FU of at least three months, stability and bony union could be assessed. Thirty-one of them achieved a bony fusion/stable construct.

CONCLUSIONS:

Contoured rod is especially useful for PF in cases of congenital AAD with coexisting CIM, cervical scoliosis, sub-axial instability and/or asymmetrical facet joints. In acquired pathologies with three-column instability, inclusion of joints one level above the affected one by using CR, especially enhances stability.

PMID:
18040109
[Indexed for MEDLINE]
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