Posterior Occipitocervical Fusion for Unstable Upper CervicalTraumainOldandElderlyPopulation,AlthoughDecreasesUpperCervical Rotation, Does Not Significantly Increase NeckDisability Index

Despite the research progress in the thoraco-lumbo-pelvic balance, cervical spine balance has only recently gainedincreasing interest. To our knowledge, there is a lack of research regarding sagittal occipitocervical spine balance restorationfollowing posterior occipitocervical fusion (POCF).Purpose. 'e primary outcome measure is the evaluation of sagittal cervicalalignmentroentgenographicparametersandthesecondaryisthefunctionaloutcome(NDI),followingPOCFforupper(C1&C2)cervical trauma (UCT) in coexistence with upper cervical spine degeneration.Patients and Methods. Twenty old and elderlypatients aged 62±12 years with evident upper cervical degeneration, who received POCF for upper C1 & C2 unstable cervicalspine injuries, were included. C2-C7 lordosis, C2-C7 SVA, spinocranial angle (SCA), T1-slope, neck tilt (NT), thorax inlet angle(TIA),cervicaltilt(CT),cranialtilt(CrT),andC0-C1angleweremeasured.'esubfusionanglewasusedtostudythebehavioroftheunfusedcervicalsegmentsbelowfusion.'eNeckDisabilityIndex(NDI)wasusedforthefunctionaloutcomeevaluation.29age-matched individuals were used as controls for radiographic analysis and self-reported functional status comparison.Results.'eroentgenographicdataweremeasured3and39±12monthspostoperatively.Twelvepatientsshowednodisability,andeightshowed mild disability. Postoperatively, the patients stood with less C2-C7 lordosis, SCA, and CT (P<0.02) but with higher NT(P<0.02) in comparison to the controls. 'e patient’s neck disability (NDI) was increasing as TIA increases (P�0.023).Subfusion angle seems to adapt to C2-C7 lordosis (P<0.0033) and C0-C2 angle (P<0.003) without any changes till the lastevaluation.Conclusions. POCF sufficiently restored occipitocervical sagittal balance along with functional outcome similar tocontrolsinadultandelderlyindividualswithevidentuppercervicaldegeneration.WedonotrecommendPOCFforyoungactiveindividuals without occipitocervical pathology, but in contrary, we recommend the removal of the spinocranial connectionhardware after cervical fusion is completed