In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Multivariate Analysis of Factors Affecting Functional Outcomes and Disposition After Atlantoaxial Fusion

    Final Number:

    Jian Guan MD; Michael Karsy MD PhD; Andrew T. Dailey MD; Meic H Schmidt; Darrel S. Brodke MD; Brandon Lawrence; Erica Fay Bisson MD, MPH, FAANS

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves 2016 Annual Meeting

    Introduction: Atlantoaxial fusion is a highly effective procedure for treating degenerative, traumatic, and congenital abnormalities that result in upper cervical instability; however, data on which factors affect patient outcome measures and length of stay are limited.

    Methods: We utilized a clinical database to identify outcomes in patients who underwent isolated posterior atlantoaxial fusion at a single institution from 2010 to 2015. Patients were excluded if additional surgical procedures were performed at time of posterior cervical fusion. Primary outcomes included length of stay, neck visual analog scale (VAS) scores, neck disability index (NDI) scores, and EuroQol scores as measured by the time tradeoff method. Additional demographic variables, as well as clinical and surgical variables were recorded. T-test and Chi-square testing as well as univariate and multivariate analysis were performed with p<0.05 considered significant.

    Results: We identified 59 patients who met inclusion and exclusion criteria. Patients demonstrated significant improvements in VAS, NDI, and EuroQol scores at 3 months and 6 months postoperatively. On multivariate analysis preoperative opioid use was shown to be significantly associated with NDI change at 6 months follow-up, and discharge location (i.e., home, skilled nursing facility, or inpatient rehabilitation) was shown to be significantly associated with length of stay.

    Conclusions: Posterior atlantoaxial fusion is a highly successful procedure resulting in significant improvements in multiple patient-reported outcomes. While various pre-, intra-, and postoperative factors may affect an individual patient’s response to and recovery from surgery, only preoperative opioid use was shown to significantly impact patient reported outcomes and only inability to discharge home was associated with a significant increase in length of stay.

    Patient Care: More comprehensive knowledge of what factors impact patient outcomes following atlantoaxial fusion will improve management of these complex patients.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the importance of different pre-operative, intra-operative and post-operative variables on length of stay and outcome following atlantoaxial fusion 2) Discuss, in small groups, what patients may benefit from atlantoaxial fusion 3) Identify what patients may be at risk for less dramatic improvement in functional status after atlantoaxial fusion

    References: 1. Kim JY, Hyun CH, Yoon SH, Park HC, Seo HS. Comparison of outcomes after atlantoaxial fusion with transarticular screws and screw-rod constructs. J Korean Neurosurg Soc. 2014;55(5):255-260. 2. Gallie WE. Skeletal traction in the treatment of fractures and dislocations of the cervical spine. Ann Surg. 1937;106(4):770-776. 3. Magerl F, Seeman P. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Society CSR, eds. Cervical Spine. Vol I: New York: Springer-Verlag;1986:322-327. 4. Goel A, Laheri V. Plate and screw fixation for atlanto-axial subluxation. Acta Neurochir (Wien). 1994;129:47-53. 5. Harms J, Melcher RP. Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976). 2001;26:2467-2471. 6. Wright NM. Posterior C2 fixation using bilateral, crossing C2 laminar screws: case series and technical note. J Spinal Disord Tech. 2004;17:158-162. 7. Coyne TJ, Fehlings MG, Wallace MC, Bernstein M, Tator CH. C1-C2 posterior cervical fusion: long-term evaluation of results and efficacy. Neurosurgery. 1995;37(4):688-692. 8. Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Frempong-Boadu A, Smith ML. Outcome comparison of atlantoaxial fusion with transarticular screws and screw-rod constructs. Meta-analysis and review of literature. J Spinal Disord Tech. 2014;27(1):11-28. 9. Lall R, Patel NJ, Resnick DK. A review of complications associated with craniocervical fusion surgery. Neurosurgery. 2010;67(5):1396-1403. 10. Gruskay JA, Fu M, Bohl DD, Webb ML, Grauer JN. Factors affecting length of stay after elective posterior lumbar spine surgery: a multivariate analysis. Spine J. 2015;15(6):1188-1195. 11. Kehlet H, Wilmore DW. Multimodal strategies to improve surgical outcome. Am J Surg. 2002;183(6):630-641. 12. Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis. 2000;31(Suppl 4):S131-138. 13. White RH, Romano PS, Zhou H, Rodrigo J, Bargar W. Incidence and time course of thromboembolic outcomes following total hip or knee arthropathy. Arch Intern Med. 1998;158:1005-1010. 14. MacDermid JC, Walton DM, Avery S, Blanchard A, Etruw E, McAlpine C, Goldsmith CH. Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther. 2009;39(5):400-417. 15. Young BA, Walker MJ, Strunce JB, Boyles RE, Whitman JM, Childs JD. Responsiveness of the Neck Disability Index in patients with mechanical neck pain. Spine J. 2009;9(10):802-808. 16. Taggard DA, Kraut MA, Clark CR, Traynelis VC. Case-control study comparing the fficacy of surgical techniques for C1-C2 arthrodesis. J Spinal Disord Tech. 2004;17:189-194. 17. Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications and lessons learned in 67 pediatric patients. J Neurosurg Spine. 2005;2:164-169. 18. Dickman CA, Sonntag VK. Posterior C1-C2 transarticular screw fixation for atlantoaxial arthrodesis. Neurosurgery. 1998;43(2):275-280. 19. Neo M, Fujibayashi S, Miyata M, Takemoto M, Nakamura T. Vertebral artery injury during cervical spine surgery: a survey of more than 5600 operations. Spine (Phila Pa 1976). 2008;33(7):779-785. 20. Neo M. An essential principle for safe C1-C2 transarticular screw insertion. J Spine Disord Tech. 2008;21(1):2 21. Ahmad FU, Wang MY. Lateral mass of C1 fixation and ponticulus-posticus. World Neurosurg. 2014. 82(1);e145-e146.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy