A strategy of combining posterior occipitocervical angle with occipital-C<sub>2</sub> angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Guangzhou ^1,2 ,  LIU Hao ¹ , DING Chen ¹ , YANG Yi ¹ , MENG Yang ¹ , DUAN Yuchen ¹ , CHEN Hua ¹ ,  HONG Ying ³

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou Sichuan, 646000, P.R.China;
3. Operating Room, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

LIU Hao, Email: liuhao6304@126.com; HONG Ying, Email: hongying518@163.com

Keywords：

Occipitocervical fusion; occipitocervical fixed angle; posterior occipitocervical angle; occipital-C₂ angle

DOI：

10.7507/1002-1892.201807115

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Objective To assess the application and the effectiveness of a strategy of combining posterior occipitocervical angle (POCA) with occipital-C₂ (O-C₂) angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion.Methods The clinical data of 22 patients undergoing posterior instrumented occipitocervical fusions between March 2013 and January 2016 were retrospectively analysed, and all patients were performed by using a strategy combining with POCA and O-C₂ angle for adjustment of occipitocervical fixation angle. All patients suffered from occipitocervical instability, including 7 males and 15 females with an average age of 44.4 years (range, 20-63 years). The patients were diagnosed as skull base depression with atlantoaxial dislocation in 20 cases and rheumatoid arthritis in 2 cases. The preoperative Japanese Orthopaedic Association (JOA) score was 13.2±2.0, and the visual analogue scale (VAS) score was 6.3±0.9. The POCA was first used to guide the pre-bending of the nail-rod system during the operation, so that POCA of 12 patients with abnormal preoperative POCA could be restored to the normal range; then intraoperative fluoroscopy was used to confirm whether the O-C₂ angle was within the normal range (4 cases were abnormal and 2 cases needed intraoperative adjustment); finally, POCA and O-C₂ angles were within normal range after adjustment. The postoperative complications were recorded, and the JOA and VAS scores were used to evaluate the recovery of spinal nerve function and the degree of pain relief after operation. The radiological data were collected to evaluate the bone graft fusion, the changes of postoperative POCA, O-C₂ angle, and lower cervical curvature (Cobb angle).Results All 22 patients were followed up 12-48 months, with an average of 24 months. No serious complications and reoperation occurred. At last follow-up, the VAS score and JOA score were 2.9±0.8 and 15.4±0.9 respectively, which were significantly improved when compared with preoperative ones (t=15.870, P=0.000; t=6.587, P=0.000). Imaging examination showed that 22 patients had occipitocervical osseous fusion, good position of internal fixator without loosening or fracture, and good occipitocervical stability. The POCA and O-C₂ angles were within the normal range at 3 days after operation and at last follow-up, and there were significant differences when compared with preoperative ones (P<0.05); but no significant difference was found in POCA and O-C₂ angles between at 3 days after operation and at last follow-up (P>0.05). There was no significant difference in Cobb angle of lower cervical spine between before and after operation (P>0.05).Conclusion The strategy of combination POCA and O-C₂ angle for adjustment of occipitocervical fixation angle during operation can ensure a better effectiveness.

Citation： LI Guangzhou, LIU Hao, DING Chen, YANG Yi, MENG Yang, DUAN Yuchen, CHEN Hua, HONG Ying. A strategy of combining posterior occipitocervical angle with occipital-C₂ angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(1): 35-40. doi: 10.7507/1002-1892.201807115 Copy

1.	Meng Y, Chen H, Lou J, et al. Posterior distraction reduction and occipitocervical fixation for the treatment of basilar invagination and atlantoaxial dislocation. Clin Neurol Neurosurg, 2016, 140: 60-67.
2.	孟阳, 戎鑫, 陈华, 等. 后路切开复位枕颈融合术治疗颅底凹陷症合并寰枢椎脱位. 中华骨科杂志, 2016, 36(10): 591-597.
3.	孟阳, 刘浩, 戎鑫, 等. 颅底凹陷症合并寰枢椎脱位患者枕颈角与下颈椎曲度的关系. 中国脊柱脊髓杂志, 2017, 27(1): 25-30.
4.	Ding X, Abumi K, Ito M, et al. A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J, 2012, 21(8): 1580-1589.
5.	Bhatia R, Desouza RM, Bull J, et al. Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era. J Neurosurg Spine, 2013, 18(4): 333-339.
6.	Garrido BJ, Sasso RC. Occipitocervical fusion. Orthop Clin North Am, 2012, 43(1): 1-9.
7.	Pan J, Huang D, Hao D, et al. Occipitocervical fusion: fix to C₂ or C₃? Clin Neurol Neurosurg, 2014, 127: 134-139.
8.	Yoshida M, Neo M, Fujibayashi S, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine (Phila Pa 1976), 2007, 32(8): E267-E270.
9.	Sakuraya F, Mayumi T, Kenmotsu O. A case of tracheotomy due to upper airway obstruction after posterior cervical fusion. Nihon Shuchu Chiryo Igakukai Zasshi, 2002, 9(suppl 1): 103.
10.	李广州, 刘浩, 唐超, 等. 不同年龄健康人群正常枕颈角度的影像学测量及临床意义. 中国骨伤, 2018, 31(7): 608-611.
11.	Bagley CA, Witham TF, Pindrik JA, et al. Assuring optimal physiologic craniocervical alignment and avoidance of swallowing-related complications after occipitocervical fusion by preoperative halo vest placement. J Spinal Disord Tech, 2009, 22(3): 170-176.
12.	Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine (Phila Pa 1976), 2001, 26(2): 161-165.
13.	Logroscino CA, Genitiempo M, Casula S. Relevance of the cranioaxial angle in the occipitocervical stabilization using an original construct: a retrospective study on 50 patients. Eur Spine J, 2009, 18 Suppl 1: 7-12.
14.	朱文俊, 杨军, 倪斌. 枕颈融合术对下颈椎曲度及退变影响的研究进展. 中国脊柱脊髓杂志, 2015, 25(7): 662-665.
15.	Takami T, Ichinose T, Ishibashi K, et al. Importance of fixation angle in posterior instrumented occipitocervical fusion. Neurol Med Chir (Tokyo), 2008, 48(6): 279-282.
16.	Shoda N, Takeshita K, Seichi A, et al. Measurement of occipitocervical angle. Spine (Phila Pa 1976), 2004, 29(10): E204-E208.
17.	Phillips FM, Phillips CS, Wetzel FT, et al. Occipitocervical neutral position. Possible surgical implication. Spine (Phila Pa 1976), 1999, 24(8): 775-778.
18.	Riel RU, Lee MC, Kirkpatrick JS. Measurement of a posterior occipitocervical fusion angle. J Spinal Disord Tech, 2010, 23(1): 27-29.
19.	Maulucci CM, Ghobrial GM, Sharan AD, et al. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion. Evid Based Spine Care J, 2014, 5(2): 163-165.
20.	Tan J, Liao G, Liu S. Evaluation of occipitocervical neutral position using lateral radiographs. J Orthop Surg Res, 2014, 9: 87.

1. Meng Y, Chen H, Lou J, et al. Posterior distraction reduction and occipitocervical fixation for the treatment of basilar invagination and atlantoaxial dislocation. Clin Neurol Neurosurg, 2016, 140: 60-67.
2. 孟阳, 戎鑫, 陈华, 等. 后路切开复位枕颈融合术治疗颅底凹陷症合并寰枢椎脱位. 中华骨科杂志, 2016, 36(10): 591-597.
3. 孟阳, 刘浩, 戎鑫, 等. 颅底凹陷症合并寰枢椎脱位患者枕颈角与下颈椎曲度的关系. 中国脊柱脊髓杂志, 2017, 27(1): 25-30.
4. Ding X, Abumi K, Ito M, et al. A retrospective study of congenital osseous anomalies at the craniocervical junction treated by occipitocervical plate-rod systems. Eur Spine J, 2012, 21(8): 1580-1589.
5. Bhatia R, Desouza RM, Bull J, et al. Rigid occipitocervical fixation: indications, outcomes, and complications in the modern era. J Neurosurg Spine, 2013, 18(4): 333-339.
6. Garrido BJ, Sasso RC. Occipitocervical fusion. Orthop Clin North Am, 2012, 43(1): 1-9.
7. Pan J, Huang D, Hao D, et al. Occipitocervical fusion: fix to C₂ or C₃? Clin Neurol Neurosurg, 2014, 127: 134-139.
8. Yoshida M, Neo M, Fujibayashi S, et al. Upper-airway obstruction after short posterior occipitocervical fusion in a flexed position. Spine (Phila Pa 1976), 2007, 32(8): E267-E270.
9. Sakuraya F, Mayumi T, Kenmotsu O. A case of tracheotomy due to upper airway obstruction after posterior cervical fusion. Nihon Shuchu Chiryo Igakukai Zasshi, 2002, 9(suppl 1): 103.
10. 李广州, 刘浩, 唐超, 等. 不同年龄健康人群正常枕颈角度的影像学测量及临床意义. 中国骨伤, 2018, 31(7): 608-611.
11. Bagley CA, Witham TF, Pindrik JA, et al. Assuring optimal physiologic craniocervical alignment and avoidance of swallowing-related complications after occipitocervical fusion by preoperative halo vest placement. J Spinal Disord Tech, 2009, 22(3): 170-176.
12. Matsunaga S, Onishi T, Sakou T. Significance of occipitoaxial angle in subaxial lesion after occipitocervical fusion. Spine (Phila Pa 1976), 2001, 26(2): 161-165.
13. Logroscino CA, Genitiempo M, Casula S. Relevance of the cranioaxial angle in the occipitocervical stabilization using an original construct: a retrospective study on 50 patients. Eur Spine J, 2009, 18 Suppl 1: 7-12.
14. 朱文俊, 杨军, 倪斌. 枕颈融合术对下颈椎曲度及退变影响的研究进展. 中国脊柱脊髓杂志, 2015, 25(7): 662-665.
15. Takami T, Ichinose T, Ishibashi K, et al. Importance of fixation angle in posterior instrumented occipitocervical fusion. Neurol Med Chir (Tokyo), 2008, 48(6): 279-282.
16. Shoda N, Takeshita K, Seichi A, et al. Measurement of occipitocervical angle. Spine (Phila Pa 1976), 2004, 29(10): E204-E208.
17. Phillips FM, Phillips CS, Wetzel FT, et al. Occipitocervical neutral position. Possible surgical implication. Spine (Phila Pa 1976), 1999, 24(8): 775-778.
18. Riel RU, Lee MC, Kirkpatrick JS. Measurement of a posterior occipitocervical fusion angle. J Spinal Disord Tech, 2010, 23(1): 27-29.
19. Maulucci CM, Ghobrial GM, Sharan AD, et al. Correlation of posterior occipitocervical angle and surgical outcomes for occipitocervical fusion. Evid Based Spine Care J, 2014, 5(2): 163-165.
20. Tan J, Liao G, Liu S. Evaluation of occipitocervical neutral position using lateral radiographs. J Orthop Surg Res, 2014, 9: 87.

Chinese Journal of Reparative and Reconstructive Surgery

A strategy of combining posterior occipitocervical angle with occipital-C₂ angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion

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Chinese Journal of Reparative and Reconstructive Surgery

A strategy of combining posterior occipitocervical angle with occipital-C2 angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion

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A strategy of combining posterior occipitocervical angle with occipital-C₂ angle for adjustment of occipitocervical fixation angle in posterior instrumented occipitocervical fusion