Injuries at the occipitocervical junction are commonly due to high velocity trauma. Because of severe injury to the cervicomedullary junction and concomitant cerebral trauma, they are usually fatal. We describe our experience in the management of five patients who initially survived the injuries. Between 1995 and 2000 we treated four men and one woman, ranging in age from 23 to 47 years, injured in motor vehicle accidents. All patients had head injuries, three with cranial nerve involvement, and four had polytrauma. Although initial radiographs of the skull included the occipitocervical junction, the traumatic disruption of the occipitocervical junction was not diagnosed for between two days and five weeks. One patient, who had no neurological deficit, developed periodic weakness of the lower limbs with rotation of the neck. In three patients the dislocation was posterior and in two it was anterior to Wackenheim’s line. Three of four patients who required ventilatory support died before surgical stabilisation. The dislocation was reduced in only one of the remaining two, both of whom underwent a successful occipitocervical fusion (O-C2), with subsequent complete neurological recovery. In patients with polytrauma, meticulous clinical evaluation and appropriate radiographic investigations of the occipitocervical junction are essential for early recognition and management of this potentially fatal injury.
Most spinal pedicle fixation systems used in this country are imported and expensive. They mostly employ rigid or semi-rigid screws with a known and significant rate of implant failure. Though they are often designed for ease of insertion, many are difficult to remove. This study investigated the radiological outcome of a dynamic spinal fixation system developed in South Africa with the aims of reducing costs, improving ease of insertion and removal, reducing the rate of implant failure, and at the same time meeting international standards. A University Ethics Committee approved this study of 439 patients in whom the device was used in spinal surgery between 1997 and 2002. Of these patients, 121 had follow-up radiographs taken more than one year after surgery. These radiographs were independently reviewed and form the basis of this study. In 93.4% of patients, the fusion was radiographically solid. The state of fusion was uncertain in 4.1%, and fusion had failed in 2.5%. Screw breakage occurred in 0.3%. There were no rod breakages. In 1% of patients there was evidence of screw-bone loosening. There were no signs of screw-rod breakage or loosening. The device produces a satisfactory rate of fusion with a very low rate of implant failure. Awarded ISO 9001:2001 certification and the CE mark, it meets international standards at considerably reduced cost.
