One-stage posterior decompression and fusion using a Luque rod for occipito-cervical instability and neural compression.

STUDY DESIGN

Original article.

OBJECTIVE

The authors present seven cases who underwent one-stage suboccipital, C1 and/or C2 posterior decompression and fusion by Luque rod, wiring and autogenic bone graft for occipito-cervical instability and neural compression.

SETTING

Chang Gung University and Medical Center at Kaohsiung, Taiwan.

METHOD

Since January 1996, 20 cases of craniovertebral and upper cervical spinal instability were encountered. Seven of these cases had no neurological improvment under Cone-Barton Skeletal traction. Imaging studies revealed poor reduction with persistent neural compression. One patient underwent unsuccessful anterior trans-oral vertebrectomy for decompression. All patients underwent posterior suboccipital craniectomy, C1 and/or C2 laminectomy for decompression. Contoured Luque rod with wiring and autogeneic bone graft was used for craniocervical fusion. After surgical treatment, halo-vest or sterno-occipito-mandibular immobilizer (SOMI) was used for 3-6 months.

RESULTS

Suboccipital craniectomy and C1 laminectomy could afford a 30-50% increment of anteroposterior diameter in the neural canal and effective decompression of the low medulla and cord. All patients made neurological improvement. The ASIA-MIS scores improved from pre-operative 49 (mean) to 78. Four patients can walk without any support. There were no major complications except for one case requiring readjustment of the halo-vest brace.

CONCLUSION

The authors recommend this procedure as one choice for relieving craniocervical instability with neurological compromise. A programmed rehabilitation will afford better neurological improvement.