Radiological Improvements and Clinical Outcomes of Occipitocervical Fusion for Traumatic Cranocervical Junction Instability

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OBJECTIVE: This study aimed to evaluate the radiological outcomes of occipitocervical fusion (OCF) for traumatic craniocervical junction (CCJ) instability by analyzing changes in preoperative and postoperative computed tomography (CT)-measured radiological parameters. METHODS: We retrospectively analyzed 20 consecutive adult trauma patients who underwent OCF for CCJ instability at a single center from January 2015 to May 2023. Clinical features, surgical outcomes, and preoperative and postoperative CT-measured parameters (basion-dens interval [BDI], basion-axial interval [BAI], atlanto-dental interval [ADI], space available for the cord, clivus-canal angle) were evaluated. Patients were grouped according to whether their preoperative parameter values were within or outside the normal range, and changes were compared between the groups. RESULTS: All patients underwent OCF without neurological deterioration, except for 1 death from polytrauma. Significant postoperative improvements were observed in BDI for patients with abnormal preoperative BDI >8.5 mm (-4.27 ± 3.67 mm) compared to those with normal BDI <8.5 mm (0.11 ± 1.84 mm, P = 0.0194), and in ADI for those with abnormal preoperative ADI >2 mm (-1.88 ± 0.61 mm vs. 0.02 ± 0.16 mm, P = 0.0011). BAI improved significantly in patients with abnormal preoperative BAI < -4 mm (9.07 ± 5.74 mm, P = 0.0154) and >12 mm (-8.45 ± 4.65 mm, P = 0.0078) compared to those within normal limits. Space available for the cord (<14 mm) and clivus-canal angle (>160° or <145°) showed trends toward improvement but without statistical significance. Postoperative complications included dysphagia (10%), hardware failure (10%), and surgical site infection (5%). CONCLUSIONS: OCF effectively stabilizes traumatic CCJ instability, improves key CT-measured radiological parameters, and supports favorable neurological outcomes.

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