Perioperative Outcomes, Technical and Patient Reported Success of Rigid Occipitocervical (OC) Fusions: a Systematic Review and Meta-Analysis of 1247 Patients

Introduction: Occipitocervical (OC) fusions are uncommon and challenging surgeries, as patients present with a wide range of pathologies. Limited literature exists characterizing OC fusion outcomes. To the authors’ knowledge, this is the first meta-analysis on OC fusions, now with a specific focus on the current preference for treatment focusing on rigid constructs.

Methods: A literature search of the Embase and MEDLINE databases was completed, and studies were included if they focused on rigid construct methods for OC fusions. Meta-analysis was completed adhering to the random effects models, where continuous variables were analyzed with pooled-weighted means (95% confidence intervals [CI]), and categorical variables with pooled-weighted prevalence rates.

Results: A total of 42 studies encompassing 1247 patients were included in this study. Included patients had a mean age of 57.18 (CI, 52.21-62.15; I^2=94.47%) with males presenting 42.77% (CI, 35.97-49.86; I^2=53%) of the time. Successful bony fusion was found in 96.72% (CI, 92.54-98.59; I^2=0%) of cases, with reoperation occurring in 4.72% (CI, 2.62-8.36; I 2 =0%) of patients. Surgical site infection was the most common complication at a rate of 6.97% (CI, 5.19-9.29; I^2=0%), followed by cerebral spinal fluid leak 2.93% (CI, 1.32-6.36; I^2 =0%), instrumentation failure 2.60% (CI, 1.16-5.71; I^2=0%), vertebral artery injury 1.64% (CI, 0.74-3.61; I^2=0%), and screw loosening 1.44% (CI, 0.65-3.16; I^2=0%).

Conclusion : Rigid OC fusions demonstrate an extremely high likelihood of successful bony fusion and lower rates of complications than previously published, demonstrating a promising current state and future of OC fusion.