Posterior cervical fixation or fusion is a surgical procedure can include only 2 adjacent segments of the spinal column, fixation the skull to the cervical spine(occipito-cervical fusion), or it may includes fixation of the whole cervical spinal area with extension to the upper thoracic spine. The fixation of the C1/2 level is not uncommon procedure and called Atlantoaxial fusion. The indication of this procedure is depending on the underlying cause of spinal instability, the most common cause is traumatic fractures followed by degenerative spinal instabilities. In some cases it is combines with an anterior spinal fusion is necessary for additional stability like in spinal infection and certain types of spinal fractures.
Target and results: The results of surgery are generally good, mostly depending on the underlying cause of spinal instability and whether the patient needs spinal decompression in addition to the spinal fusion.
Risk of complications:
- Infection is less than 2 percent. It may affect the superficial tissues and skin, or may affect deep spinal structures, diskitis or vertebral osteomyelitis which is very rare. Revision of metal implants may be necessory in case of infection.
- Bleeding which may lead to hematoma collection that may need further surgery.
- Cerebrospinal fluid (CSF) leak, inadvertent breach of the thecal sac may lead to leaking of the fluid surrounding the brain and the spinal cord. Instant repairs is possible, however, it may need an extended admission in the hospital or further procedures. There is also very small risk of meningitis.
- Neural tissue injury: the most serious complication may cause life changing consequences in form of weakness or paralysis of arms, legs, sphincters, sensory or sexual changes. The risk is very small, <1%.
- Worsening of neck pain which is about 20%, most of the patient will improve after 4 weeks after the surgery. However, chronic neck pain is not uncommon. it may related to adjacent level degeneration
- Injury to the major vessels that supply the brain with blood may lead to stroke and devastating consequences, however, the risk is very small.
- Failure to improve symptoms.
- Failure of the spinal fusion process with loosening of the metal implants may need revision of the spinal fusion.
- General anesthetic complications (heart attack, stroke)
- Deep venous thrombosis/pulmonary embolism (clots in legs /
lungs).