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

Abstract

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. 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. 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%). OCF effectively stabilizes traumatic CCJ instability, improves key CT-measured radiological parameters, and supports favorable neurological outcomes.