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Craniocervical instability
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==== Outcomes, risks & complications ==== Little research on outcomes exists. In a small case study of 20 patients, the five-year outcome of OCF was generally favorable with most patients experiencing symptom relief post-surgery.<ref name=":0" /> In this study, following 20 EDS patients five years free O-2 fusion, most reported they were satisfied with the surgery and experienced significant improvements in symptoms such as vertigo, headaches, imbalance, dysarthria, dizziness, and frequent daytime urination. There was, however, only a small increase in objective outcomes such as work resumption, with 60% of patients remaining unable to work or go to school. Participants attributed this to other EDS comorbidities such as POTS, Mast Cell Activation Syndrome, and additional spinal problems.<ref name=":0" /> The complications of OCF can be serious<ref>{{Cite journal | last = Garrido|first = Ben J. | last2 = Sasso | first2 = Rick C. | date = Jan 2012 | title = Occipitocervical fusion | url =https://www.ncbi.nlm.nih.gov/pubmed/22082624|journal=The Orthopedic Clinics of North America|volume=43|issue=1 | pages = 1β9, vii|doi=10.1016/j.ocl.2011.08.009|issn=1558-1373|pmid=22082624}}</ref> and occur in an estimated 7% to 33% of patients.<ref name=":10" /><ref name=":18">{{Cite journal | last = Winegar | first = Corbett D. | last2 = Lawrence | first2 = James P. | last3 = Friel | first3 = Brian C. | last4 = Fernandez | first4 = Carmella | last5 = Hong | first5 = Joseph | last6 = Maltenfort | first6 = Mitchell | last7 = Anderson | first7 = Paul A. | last8 = Vaccaro | first8 = Alexander R. | date = Jul 2010 | title = A systematic review of occipital cervical fusion: techniques and outcomes |url =https://www.ncbi.nlm.nih.gov/pubmed/20594011|journal=Journal of Neurosurgery. Spine|volume=13|issue=1 | pages = 5β16|doi=10.3171/2010.3.SPINE08143|issn=1547-5646|pmid=20594011}}</ref><ref name=":11" /><ref>{{Cite journal | last = Ando|first = Kei | last2 = Imagama | first2 = Shiro | last3 = Ito | first3 = Zenya | last4 = Kobayashi | first4 = Kazuyoshi | last5 = Yagi | first5 = Hideki | last6 = Shinjo | first6 = Ryuichi | last7 = Hida | first7 = Tetsuro | last8 = Ito | first8 = Kenyu | last9 = Ishikawa | first9 = Yoshimoto | date = Jun 2017 | title = Minimum 5-year Follow-up Results for Occipitocervical Fusion Using the Screw-Rod System in Craniocervical Instability | url = https://www.ncbi.nlm.nih.gov/pubmed/28525489|journal=Clinical Spine Surgery|volume=30|issue=5| pages = E628βE632|doi=10.1097/BSD.0000000000000199|issn=2380-0194|pmid=28525489}}</ref><ref name=":16" /> Common complications include screw failure, wound infection, dural tear and cerebrospinal fluid leakage<ref name=":11" /> In some cases revision surgery is needed to treat infection or to remove hardware. Severe complications can include meningitis and accidental injury of the vertebral artery by misplaced screws.<ref name=":17">{{Cite journal | last = Nockels | first = Russ P. | last2 = Shaffrey | first2 = Christopher I. | last3 = Kanter | first3 = Adam S. | last4 = Azeem | first4 = Syed | last5 = York | first5 = Julie E. | date = Aug 2007 | title = Occipitocervical fusion with rigid internal fixation: long-term follow-up data in 69 patients |url =https://www.ncbi.nlm.nih.gov/pubmed/17688049|journal=Journal of Neurosurgery. Spine|volume=7|issue=2 | pages = 117β123|doi=10.3171/SPI-07/08/117|issn=1547-5654|pmid=17688049}}</ref> A meta-study of 2274 procedures across 22 studies<ref name=":16" /> found the following complication rates: {| class="wikitable" !Complication type !Prevalence rate |- |Hardware failure after fusion non-union |7% |- |Wound infection |3.8%-11% |- |Vertebral artery damage |1.3%-4.1% |- |Dural tears |0% to 4.2% |} Meta-studies place the rate of death from fusion surgery at 0-0.6%.<ref name=":16" /><ref name=":18" />
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