Threaded Steinmann Pin Fusion of the Craniovertebral Junction

Department

neurosurgery

Document Type

Article

Abstract

Study Design. In a clinical retrospective study, the authors review Long-term results of occipitocervical fusion using a wide diameter, contoured, threaded Steinmann pin. Objectives. To evaluate the clinical and radiographic results of occipitocervical fusion using this technique in a variety of abnormalities including rheumatoid arthritis. Summary of Background Data. The various surgical techniques and hardware developed for occipitocervical fusion have been associated with mixed results, particularly in patients with rheumatoid arthritis or basilar invagination. Methods. Thirty-nine patients with occipitocervical instability were internally fixed with a wide diameter, contoured, threaded Steinmann pin wired to the occiput and cervical laminae or facets. Fusion was facilitated using autologous iliac crest bone graft and a cervical orthosis. Instability resulted from rheumatoid arthritis (n = 12), congenital anomalies (n = 12), trauma (n = 10), tumor (n = 4), or osteogenesis imperfects (n = 1). Fifteen patients had radiographic evidence of basilar invagination. Long-term outcome (mean follow-up period, 38.9 months; range, 12-78 months) was based on clinical and radiographic review. Results. Thirty-seven patients (97%) had a stable postoperative occipitocervical construct: there were 35 osseous unions, two fibrous unions, and one nonunion. There was one postoperative death from pulmonary complications. No patient developed evidence of new, recurrent, or progressive basilar invagination. Conclusion. The authors concluded that rigid segmental fixation of the craniovertebral junction using a wide diameter, contoured, threaded Steinmann pin end supplemental autograft creates excellent fusion with minimal complications. This technique is appropriate for a variety of abnormalities including rheumatoid arthritis.

Publication Date

1996

Publication Title

Spine

ISSN

0362-2436

Volume

21

Issue

14

First Page

1630

Last Page

1637

Digital Object Identifier (DOI)

10.1097/00007632-199607150-00004

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