Early complications of posterior rod-screw fixation of the cervical and upper thoracic spine

OBJECTIVE: The technique of rod-screw fixation of the cervical spine is well described. However, there is very little data on the complications incurred by the application of these devices. The purpose of this study was to quantify the risks associated with rod fixation of the cervical spine. METHODS: A prospective study was performed on 100 consecutive patients treated with this technique. Clinical and radiographic assessment was performed immediately after surgery 3, 6, and 12 months postoperatively, and annually thereafter. The mean follow-up interval was 16.7 months. RESULTS: A total of 888 screws were implanted in 100 patients. Perioperative complications included radiculopathy (n = 4, 0.45% per screw placed), infection and other wound-healing problems (n = 4), screw malposition (n = 2), loss of alignment (n = 1), and cerebrospinal fluid leak (n = 1). There were no examples of spinal cord or vertebral artery injury. Early complications (within 6 mo of surgery) included pseudarthrosis (n = 2) and screw breakage (n = 2, 0.22% per screw placed). There were no late complications. Reoperation was required in eight cases, all within 6 months of the index procedure. Indications for reoperation included wound-healing problems (n = 4), malpositioned screw (n = 2), and pseudarthrosis (n = 2). No patient required another operation for any indication beyond the 6-month postoperative interval. CONCLUSION: Rod-screw fixation was an effective method of posterior cervical stabilization that could be safely applied in a wide range of spinal disorders. In a complex group of patients, the complication rates were modest, and compared favorably with other methods of fixation.