Our Summary

The research paper discusses a surgical procedure known as occipitocervical fusion (OCF), which is performed to stabilize the junction between the skull and the neck. This is a complex surgery due to the unique structure and movement of this region. The current standard method uses screws, rods, and a plate to create a solid structure that doesn’t require additional support after the operation. This technique has a high success rate for creating fusion between the skull and neck bones.

However, there are some challenges with this method, such as variations in the thickness of the skull bone at the side and the structure of the vein that runs through the area. New techniques using different types of screws are being developed to address these issues.

One thing to note is that this area of the spine allows for a lot of movement - it’s responsible for 40% of the forward-backward movement of the neck, 60% of neck rotation, and 10% of side-to-side movement. So, stabilizing this area significantly reduces neck movements.

Before the operation, it’s necessary to carefully study the anatomy of the patient’s neck and to check whether it’s possible to insert screws. During the operation, a technique called fluoroscopy (which is like a real-time X-ray) is used to see what’s happening inside the body.

The operation also involves placing a bone graft around the treated area. This is because the ultimate goal of the operation is not just to stabilize the area temporarily with implants, but to encourage the bones to fuse together and become naturally stable.

FAQs

  1. What is the purpose of occipitocervical fusion (OCF)?
  2. What are the advancements in surgical techniques for OCF?
  3. What are the preoperative assessments needed before performing an OCF procedure?

Doctor’s Tip

A doctor might tell a patient undergoing spinal fusion surgery to follow their postoperative instructions carefully, including avoiding heavy lifting and bending, as well as attending physical therapy sessions to aid in the recovery process. They may also emphasize the importance of proper nutrition and staying hydrated to support the body’s healing process. Additionally, the doctor may advise the patient to quit smoking, as it can hinder the fusion process and increase the risk of complications.

Suitable For

Patients who are typically recommended for spinal fusion include those with:

  • Instability at the craniocervical junction (CCJ)
  • Degenerative disc disease
  • Scoliosis or other spinal deformities
  • Spinal fractures or trauma
  • Spinal tumors
  • Failed previous spinal surgery
  • Severe spinal stenosis
  • Spondylolisthesis
  • Kyphosis

It is important for patients to undergo a thorough evaluation by a neurosurgeon to determine if spinal fusion is the most appropriate treatment option for their specific condition.

Timeline

Preoperative phase:

  1. Patient presents with symptoms of instability at the craniocervical junction.
  2. Imaging studies such as X-rays, CT scans, and MRIs are performed to assess the extent of the instability.
  3. Surgeon determines the need for occipitocervical fusion and discusses the procedure with the patient.
  4. Preoperative assessment of vertebral artery anatomy and feasibility of screw insertion is conducted.
  5. Surgical plan is developed, including choice of surgical technique and type of implants to be used.

Surgical phase:

  1. Patient undergoes occipitocervical fusion surgery, which involves internal rigid fixation with polyaxial screws, contoured rods, and an occipital plate.
  2. Newer techniques such as occipital condyle screw or transarticular occipito-condylar screws may be used to address limitations of occipital fixation.
  3. Structural and supplemental bone graft is placed around decorticated bony elements to promote bony fusion.
  4. Surgery aims to provide stability and immobilization until bony fusion can occur.

Postoperative phase:

  1. Patient is monitored in the hospital for a few days for pain management and to ensure proper healing.
  2. Physical therapy may be initiated to help the patient regain strength and mobility.
  3. Follow-up appointments with the surgeon are scheduled to monitor healing progress and assess the fusion.
  4. Patient gradually resumes normal activities, with restrictions on heavy lifting and strenuous activities.
  5. Over time, the patient experiences improved stability and reduced symptoms related to craniocervical junction instability.

What to Ask Your Doctor

  1. What is the specific reason for recommending spinal fusion surgery for my condition?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the expected recovery time and rehabilitation process after spinal fusion surgery?
  4. How will spinal fusion surgery affect my daily activities and quality of life?
  5. What are the alternative treatment options available for my condition?
  6. How successful is spinal fusion surgery in treating my specific condition?
  7. What is the long-term outlook for my condition after spinal fusion surgery?
  8. Will I need to undergo any additional procedures or surgeries in the future following spinal fusion surgery?
  9. How experienced are you in performing spinal fusion surgeries, and what is your success rate?
  10. Are there any specific guidelines or precautions I should follow before and after spinal fusion surgery?

Reference

Authors: Ashafai NS, Visocchi M, Wąsik N. Journal: Acta Neurochir Suppl. 2019;125:247-252. doi: 10.1007/978-3-319-62515-7_35. PMID: 30610329