Occipitocervical fusion in elderly patients

Michelle J. Clarke, L. Gerard Toussaint, Ramesh Kumar, David Daniels, Jeremy L. Fogelson, William E. Krauss

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Background: Occipitocervical disease (OCD) in elderly patients will become increasingly common as the population ages. Our experience with occipitocervical fusions (OCF) in this population suggests mixed outcomes. Methods: Twenty consecutive patients over 65 years old underwent OCF between 1995 and 2005. A retrospective review of demographic, presentation, surgical and outcome data was performed. Results: Twenty patients averaging 75.3 years of age (range 65 to 91) were identified. All patients had evidence of myelopathy; however, the primary surgical indications were progressive spinal cord dysfunction (15), brainstem compression (3), and pain (2). Surgical approach was isolated posterior (9), or anterior transoral odontoidectomy followed by posterior stabilization (11). Overall, surgery improved function modestly; average modified Japanese Orthopedic Association functional score (improved 0.9 grades), average Ranawat Myelopathy Score (improved 0.4 grades), and average Nurick Myelopathy Grade (improved 0.6 grades). However, patients with poor preoperative functional assessment (Ranawat grade < III) had greater neurologic improvement than those with good preoperative function, measured by Nurick grade improvement (1 vs. -0.28; P =.03) and Ranawat grade improvement (0.7 vs. -0.2; P =.03). Additionally, the posterior approach demonstrated significant improvement in Japanese Orthopedic Association functional assessment over patients with anterior/posterior approaches (2.2 vs. -0.3; P =.03), with fewer complications (posterior: 1 minor; anterior/posterior: 1 death, 2 major, 8 minor). Perioperative mortality occurred in 5%, and major morbidity in 10% of patients. Conclusions: Preventing or stabilizing neurologic deficit in patients with OCD may require OCF, despite the patient's age. In the elderly population, our data favor using the posterior approach when possible, and demonstrate greater neurologic improvement in patients with poor preoperative function.

Original languageEnglish (US)
Pages (from-to)318-325
Number of pages8
JournalWorld Neurosurgery
Volume78
Issue number3-4
DOIs
StatePublished - Sep 2012

Fingerprint

Spinal Cord Diseases
Nervous System
Orthopedics
Population
Neurologic Manifestations
Brain Stem
Spinal Cord
Demography
Morbidity
Pain
Mortality

Keywords

  • Cervical instability
  • Elderly
  • Occipitocervical disease
  • Occipitocervical fusion

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Clarke, M. J., Toussaint, L. G., Kumar, R., Daniels, D., Fogelson, J. L., & Krauss, W. E. (2012). Occipitocervical fusion in elderly patients. World Neurosurgery, 78(3-4), 318-325. https://doi.org/10.1016/j.wneu.2011.10.037

Occipitocervical fusion in elderly patients. / Clarke, Michelle J.; Toussaint, L. Gerard; Kumar, Ramesh; Daniels, David; Fogelson, Jeremy L.; Krauss, William E.

In: World Neurosurgery, Vol. 78, No. 3-4, 09.2012, p. 318-325.

Research output: Contribution to journalReview article

Clarke, MJ, Toussaint, LG, Kumar, R, Daniels, D, Fogelson, JL & Krauss, WE 2012, 'Occipitocervical fusion in elderly patients', World Neurosurgery, vol. 78, no. 3-4, pp. 318-325. https://doi.org/10.1016/j.wneu.2011.10.037
Clarke MJ, Toussaint LG, Kumar R, Daniels D, Fogelson JL, Krauss WE. Occipitocervical fusion in elderly patients. World Neurosurgery. 2012 Sep;78(3-4):318-325. https://doi.org/10.1016/j.wneu.2011.10.037
Clarke, Michelle J. ; Toussaint, L. Gerard ; Kumar, Ramesh ; Daniels, David ; Fogelson, Jeremy L. ; Krauss, William E. / Occipitocervical fusion in elderly patients. In: World Neurosurgery. 2012 ; Vol. 78, No. 3-4. pp. 318-325.
@article{1d95aed60cf948abbad739d53315cb7b,
title = "Occipitocervical fusion in elderly patients",
abstract = "Background: Occipitocervical disease (OCD) in elderly patients will become increasingly common as the population ages. Our experience with occipitocervical fusions (OCF) in this population suggests mixed outcomes. Methods: Twenty consecutive patients over 65 years old underwent OCF between 1995 and 2005. A retrospective review of demographic, presentation, surgical and outcome data was performed. Results: Twenty patients averaging 75.3 years of age (range 65 to 91) were identified. All patients had evidence of myelopathy; however, the primary surgical indications were progressive spinal cord dysfunction (15), brainstem compression (3), and pain (2). Surgical approach was isolated posterior (9), or anterior transoral odontoidectomy followed by posterior stabilization (11). Overall, surgery improved function modestly; average modified Japanese Orthopedic Association functional score (improved 0.9 grades), average Ranawat Myelopathy Score (improved 0.4 grades), and average Nurick Myelopathy Grade (improved 0.6 grades). However, patients with poor preoperative functional assessment (Ranawat grade < III) had greater neurologic improvement than those with good preoperative function, measured by Nurick grade improvement (1 vs. -0.28; P =.03) and Ranawat grade improvement (0.7 vs. -0.2; P =.03). Additionally, the posterior approach demonstrated significant improvement in Japanese Orthopedic Association functional assessment over patients with anterior/posterior approaches (2.2 vs. -0.3; P =.03), with fewer complications (posterior: 1 minor; anterior/posterior: 1 death, 2 major, 8 minor). Perioperative mortality occurred in 5{\%}, and major morbidity in 10{\%} of patients. Conclusions: Preventing or stabilizing neurologic deficit in patients with OCD may require OCF, despite the patient's age. In the elderly population, our data favor using the posterior approach when possible, and demonstrate greater neurologic improvement in patients with poor preoperative function.",
keywords = "Cervical instability, Elderly, Occipitocervical disease, Occipitocervical fusion",
author = "Clarke, {Michelle J.} and Toussaint, {L. Gerard} and Ramesh Kumar and David Daniels and Fogelson, {Jeremy L.} and Krauss, {William E.}",
year = "2012",
month = "9",
doi = "10.1016/j.wneu.2011.10.037",
language = "English (US)",
volume = "78",
pages = "318--325",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "3-4",

}

TY - JOUR

T1 - Occipitocervical fusion in elderly patients

AU - Clarke, Michelle J.

AU - Toussaint, L. Gerard

AU - Kumar, Ramesh

AU - Daniels, David

AU - Fogelson, Jeremy L.

AU - Krauss, William E.

PY - 2012/9

Y1 - 2012/9

N2 - Background: Occipitocervical disease (OCD) in elderly patients will become increasingly common as the population ages. Our experience with occipitocervical fusions (OCF) in this population suggests mixed outcomes. Methods: Twenty consecutive patients over 65 years old underwent OCF between 1995 and 2005. A retrospective review of demographic, presentation, surgical and outcome data was performed. Results: Twenty patients averaging 75.3 years of age (range 65 to 91) were identified. All patients had evidence of myelopathy; however, the primary surgical indications were progressive spinal cord dysfunction (15), brainstem compression (3), and pain (2). Surgical approach was isolated posterior (9), or anterior transoral odontoidectomy followed by posterior stabilization (11). Overall, surgery improved function modestly; average modified Japanese Orthopedic Association functional score (improved 0.9 grades), average Ranawat Myelopathy Score (improved 0.4 grades), and average Nurick Myelopathy Grade (improved 0.6 grades). However, patients with poor preoperative functional assessment (Ranawat grade < III) had greater neurologic improvement than those with good preoperative function, measured by Nurick grade improvement (1 vs. -0.28; P =.03) and Ranawat grade improvement (0.7 vs. -0.2; P =.03). Additionally, the posterior approach demonstrated significant improvement in Japanese Orthopedic Association functional assessment over patients with anterior/posterior approaches (2.2 vs. -0.3; P =.03), with fewer complications (posterior: 1 minor; anterior/posterior: 1 death, 2 major, 8 minor). Perioperative mortality occurred in 5%, and major morbidity in 10% of patients. Conclusions: Preventing or stabilizing neurologic deficit in patients with OCD may require OCF, despite the patient's age. In the elderly population, our data favor using the posterior approach when possible, and demonstrate greater neurologic improvement in patients with poor preoperative function.

AB - Background: Occipitocervical disease (OCD) in elderly patients will become increasingly common as the population ages. Our experience with occipitocervical fusions (OCF) in this population suggests mixed outcomes. Methods: Twenty consecutive patients over 65 years old underwent OCF between 1995 and 2005. A retrospective review of demographic, presentation, surgical and outcome data was performed. Results: Twenty patients averaging 75.3 years of age (range 65 to 91) were identified. All patients had evidence of myelopathy; however, the primary surgical indications were progressive spinal cord dysfunction (15), brainstem compression (3), and pain (2). Surgical approach was isolated posterior (9), or anterior transoral odontoidectomy followed by posterior stabilization (11). Overall, surgery improved function modestly; average modified Japanese Orthopedic Association functional score (improved 0.9 grades), average Ranawat Myelopathy Score (improved 0.4 grades), and average Nurick Myelopathy Grade (improved 0.6 grades). However, patients with poor preoperative functional assessment (Ranawat grade < III) had greater neurologic improvement than those with good preoperative function, measured by Nurick grade improvement (1 vs. -0.28; P =.03) and Ranawat grade improvement (0.7 vs. -0.2; P =.03). Additionally, the posterior approach demonstrated significant improvement in Japanese Orthopedic Association functional assessment over patients with anterior/posterior approaches (2.2 vs. -0.3; P =.03), with fewer complications (posterior: 1 minor; anterior/posterior: 1 death, 2 major, 8 minor). Perioperative mortality occurred in 5%, and major morbidity in 10% of patients. Conclusions: Preventing or stabilizing neurologic deficit in patients with OCD may require OCF, despite the patient's age. In the elderly population, our data favor using the posterior approach when possible, and demonstrate greater neurologic improvement in patients with poor preoperative function.

KW - Cervical instability

KW - Elderly

KW - Occipitocervical disease

KW - Occipitocervical fusion

UR - http://www.scopus.com/inward/record.url?scp=84866627764&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84866627764&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2011.10.037

DO - 10.1016/j.wneu.2011.10.037

M3 - Review article

VL - 78

SP - 318

EP - 325

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 3-4

ER -