Correlation Between Post-Operative Complications and Degree of Sagittal Correction in Occipitocervical Fusion

Introduction: Occipitocervical (OC) fusion is an indicated procedure for a variety of pathologies, including but not limited to traumatic injuries, basilar invagination, and rheumatoid arthritis. Prior studies have reported on measuring the degree of deformity correction observed with OC fusion, and post-operative complications following OC fusion. However, to our knowledge, no prior studies have compared how the degree of deformity correction correlates with post-operative complications.

Methods: Medical records were reviewed from patients who underwent OC fusion at a single institution over 5 consecutive years. Baseline patient demographics, comorbidities, indication for surgery, and degree of deformity correction (occiput-C2 [OC2], C1-C2, and C2-C7 cobb angles) were measured for pre-operative versus post-operative films. Post-operative complications including tracheostomy (trach) and need for percutaneous endoscopic gastrotomy (PEG) tube were noted. Univariate and multivariate analysis were performed to assess if variables correlated with the need for post-operative trach or PEG.

Results: In this study, 83 subjects underwent OC fusion, of which trauma was an indication in 44 of 83 (53%) patients. Age, sex, smoking status, ASA classification, and degree of C1-C2 and C2-C7 were not independent predictors of the need for post-operative trach or PEG. Correction of the OC2 deformity was angle was a significant predictor of the need for both trach and PEG. Mean OC2 correction for patients who did not require trach was +1.9 as compared to -10.6 for patients who did require trach (p = .004). Similarly, mean OC2 correction for patients who did not require PEG was +2.7 versus -12.2 for patients who did require PEG (p < .001).

Conclusion : In this sample of patients who underwent OC fusion, the degree of occipito-cervical sagittal (OC2) correction correlated with an increased probability of post-operative tracheostomy and PEG. The degree of C1-C2 and C2-C7 deformity correction did not correlate significantly with post-operative tracheostomy or PEG.