Inestabilidad craneocervical: Técnica de fijación occipitocervical rígida
Keywords:
spinal fusion instrumentation, cervical vertebrae surgery, atlanto-occipital joint, atlanto-axial joint, bone screwsAbstract
Introduction: Surgical instrumentation used for posterior occipitocervical instability has evolved from external halo restraint techniques through rigid internal fixation with sublaminar wire to modular rigid internal fixation (rods, plates, screws, hooks, connectors). This study evaluates the clinical experience in patients with rigid fixation technique.
Methods: A descriptive, case series study was designed in order to analyze the experience with rigid fixation technique, performed at the Hospital Militar Central in Bogotá - Colombia. Series include thirty patients who underwent surgery, further epidemiologically analyzed in relation with their surgical outcomes.
Results: Mean age was 53.4 years (22-80), female gender, 66.7% and 33.3% male. The most common surgical indication was rheumatoid arthritis (60%), congenital anomalies (16.6%), trauma (13.3%) and neoplastic disease and tumors (10%). Complications included deep infection showed 13.3 %, superficial 10 %, bone failure (loosening of implants) 10 %, 3.3 % seroma. Two patients were reoperated for removal of implants and 2 presented late bone failure (avulsion of implants). Two patients died due to medical conditions not directly associated with the surgical technique.
Discussion: We recommend the technique described for occipitocervical stabilization, as it facilitates early rehabilitation of patients. Cranial cervical instability surgical related complications are higher in comparison with traditional high or low cervical fixation techniques, probably related to age, diagnosis and comorbidities, but are consistent with reports from the international literature.
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