22590 Arthrodesis, posterior technique, craniocervical (occiput-C2)

Name of the Procedure:

Arthrodesis, Posterior Technique, Craniocervical (Occiput-C2)

Summary

Arthrodesis using the posterior technique for craniocervical fusion involves surgically fusing the bones at the base of the skull (occiput) to the second cervical vertebra (C2) to stabilize this region and alleviate pain or neurological deficits.

Purpose

The procedure is performed to treat instability in the craniocervical junction, often due to trauma, degenerative diseases, congenital abnormalities, or tumors. The goal is to prevent abnormal movements that cause pain or nerve damage and to restore stability and alignment.

Indications

• Chronic neck pain due to instability
• Neurological symptoms such as numbness, weakness, or difficulty walking
• Fractures or dislocations of the cervical spine
• Congenital anomalies like Chiari malformation
• Rheumatoid arthritis affecting the cervical spine

Preparation

• Fasting for at least 8 hours before surgery
• Adjustments to medications, particularly blood thinners
• Pre-operative imaging tests such as MRI or CT scans
• Pre-surgical evaluation of general health including blood tests and cardiac assessment

Procedure Description

1. The patient is placed under general anesthesia.
2. A posterior incision is made at the back of the neck.
3. Muscles are carefully retracted to expose the occiput, C1, and C2 vertebrae.
4. Bone graft material is prepared, either from the patient or a donor, and placed between these vertebrae.
5. Screws and rods are fixed to secure the bones in place and facilitate fusion.
6. The surgical site is closed using sutures or staples.
7. A postoperative brace may be applied to immobilize the neck during healing.

Duration

The procedure typically takes 3 to 6 hours.

Setting

This procedure is performed in a hospital operating room.

Personnel

• Orthopedic or neurosurgeon
• Anesthesiologist
• Surgical nurses and technicians
• Radiologic technologist (for intraoperative imaging)

Risks and Complications

• Infection
• Blood loss
• Nerve damage or spinal cord injury
• Nonunion or failure of the bones to fuse
• Hardware failure or migration
• Persistent pain or limited neck mobility

Benefits

• Stabilizes the craniocervical junction
• Alleviates neck pain
• Reduces or eliminates neurological symptoms
• Improves overall quality of life

Recovery

• Hospital stay for several days post-surgery
• Pain management with medications
• Neck brace for immobilization (6-12 weeks)
• Gradual return to regular activities over 3-6 months
• Follow-up appointments for monitoring healing and hardware position

Alternatives

• Conservative management with physical therapy and medications
• Less invasive surgical techniques if applicable
• External stabilization devices like neck braces or collars

Patient Experience

Patients can expect some post-operative pain and discomfort, managed with medications. Initial immobility and restricted activities are necessary to ensure proper healing. Regular follow-up and imaging will help monitor recovery and address any complications promptly. Most patients experience significant relief from symptoms and improved stability after recovery.