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Neurology India
Medknow Publications on behalf of the Neurological Society of India
ISSN: 0028-3886
EISSN: 1998-4022
Vol. 55, No. 4, 2007, pp. 363-368
Bioline Code: ni07108
Full paper language: English
Document type: Research Article
Document available free of charge

Neurology India, Vol. 55, No. 4, 2007, pp. 363-368

 en Occipitocervical contoured rod stabilization: Does it still have a role amidst the modern stabilization techniques?
Kalra, Samir K; Jain, Vijendra K; Jaiswal, Awadesh K & Behari, Sanjay

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.

Keywords
Atlantoaxial dislocation, contoured rod, craniovertebral junction, posterior fusion

 
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