Introduction
Materials and methods
Subject enrollment
Evaluation
Statistical analysis
Inclusion criteria for C1-C2 fusion surgery
Conservative treatment
Operative technique
Post-operative management
Statement of human and animal rights
Results
Study subjects
Neurological findings
Radiological findings pre-operatively
The Karnofsky Performance score (KPS)
Improvement in the Short Form Health Survey
Limitation measure | % with limitation pre-op | % with limitation post-op | % with improvement post-op* | % with worsening post-op† | % with onset post-op | P value‡ |
---|---|---|---|---|---|---|
Vigorous activities (running, lifting, etc.) | 100% | 95% (19/20) | 45% (9/20) | 5% (1/20) | 0 | 0.01 |
Moderate activities (vacuuming, bowling, etc.) | 95% (19/20) | 80% (16/20) | 52.7% (10/19) | 5.3% (1/19) | 5% (1/20) | 0.14 |
Lifting or carrying groceries | 85% (17/20) | 65% (13/20) | 58.8% (10/17) | 11.8% (2/17) | 5% (1/20) | 0.11 |
Climbing several flights of stairs | 90% (18/20) | 83.3% (17/20) | 38.9% (7/18) | 5.6% (1/18) | 5% (1/20) | 0.10 |
Climbing one flight of stairs | 65% (13/20) | 60% (12/20) | 45% (9/20) | 0 | 30% (3/20) | 0.17 |
Bending, kneeling, stooping | 85% (17/20) | 75% (15/20) | 52.9% (9/17) | 17.6% (3/17) | 5% (1/20) | < 0.05 |
Walking more than a mile | 90% (18/20) | 75% (15/20) | 47.1% (9/18) | 5.6% (1/18) | 5% (1/20) | 0.09 |
Walking several hundred yards | 75% (15/20) | 50% (10/20) | 66.7% (10/15) | 6.7% (1/15) | 5% (1/20) | 0.02 |
Walking 100 yards | 55% (11/20) | 35% (7/20) | 72.3% (8/11) | 0 | 5% (1/20) | 0.11 |
Bathing and dressing yourself | 60% (12/20) | 45% (9/20) | 58.3% (7/12) | 0 | 10% (2/20) | 0.18 |
Symptoms showing significant improvement after surgery
Symptom/problem | % pre-surgery | % post-surgery | % with improvement in frequency post-surgery* | % with worsening of frequency post-surgery* | Frequency P value† | % with onset post-surgery | % with improvement severity post-surgery* | % with worsening of severity post-surgery* | Severity P value† |
---|---|---|---|---|---|---|---|---|---|
Neck pain | 100% | 100% | 50% (10/20) | 0 | < 0.01 | 0 | 75% (15/20) | 0 | < 0.001 |
Headaches | 100% | 100% | 55% (11/20) | 10% (2/20) | < 0.05 | 0 | 65% (13/20) | 5% (1/20) | < 0.01 |
Occipital neuralgia | 85% (17/20) | 80% (16/20) | 52.9% (9/17) | 5.8% (1/17) | 0.01 | 0 | 58.8% (10/17) | 5.8% (1/17) | < 0.01 |
Muscle pain | 100% | 100% | 35% (7/20) | 0 | < 0.05 | 0 | 40% (8/20) | 10% (2/20) | < 0.05 |
Joint pain | 95% (19/20) | 95% (19/20) | 26.3% (5/19) | 0 | < 0.05 | 0 | 31.6% (6/19) | 0 | < 0.05 |
Numbness hands | 95% (19/20) | 85% (17/20) | 68.4% (13/19) | 0 | 0.001 | 0 | 68.4% (13/19) | 0 | 0.001 |
Numbness elsewhere (LE) | 95% (19/20) | 80% (16/20) | 68.4% (13/19) | 0 | 0.001 | 0 | 57.9% (11/19) | 0 | < 0.01 |
Weakness arms | 75% (15/20) | 60% (12/20) | 60% (9/15) | 13.3% (2/15) | 0.01 | 0 | 53.3% (8/15) | 13.3% (2/15) | < 0.05 |
Lightheadedness | 100% | 100% | 55% (11/20) | 0 | < 0.01 | 0 | 40% (8/20) | 10% (2/20) | 0.07 |
Palpitations | 80% (16/20) | 75% (15/20) | 37.5% (6/16) | 6.3% (1/16) | < 0.05 | 0 | 43.8% (7/16) | 12.5% (2/16) | 0.07 |
Dizziness | 100% | 100% | 60% (12/20) | 15% (3/20) | < 0.05 | 0 | 50% (10/20) | 15% (3/20) | 0.07 |
Pre-syncope | 90% (18/20) | 55% (11/20) | 61.1% (11/18) | 11.1% (2/18) | < 0.01 | 0 | 61.1% (11/18) | 11.1% (2/18) | < 0.05 |
Syncope | 45% (9/20) | 25% (5/20) | 66.7% (6/9) | 0 | < 0.05 | 0 | 66.7% (6/9) | 0 | < 0.05 |
Brain fog | 100% | 100% | 40% (8/20) | 0 | 0.01 | 0 | 40% (8/20) | 20% (4/20) | 0.15 |
Tremors | 60% (12/20) | 60% (12/20) | 50% (6/12) | 0 | 0.05 | 5% (1/20) | 58.3% (7/12) | 8.3% (1/12) | 0.10 |
Vertigo | 75% (15/20) | 65% (13/20) | 60% (9/15) | 0 | 0.01 | 5% (1/20) | 53.3% (8/15) | 13.3% (2/15) | 0.05 |
Nausea | 90% (18/20) | 75% (15/20) | 61.1% (11/18) | 11.1% (2/18) | < 0.05 | 0 | 44.4% (8/18) | 16.7% (3/18) | < 0.05 |
Exercise intolerance | 85% (17/20) | 80% (16/20) | 52.9% (9/17) | 5.9% (1/17) | 0.06 | 0 | 64.7% (11/17) | 11.8% (2/17) | < 0.05 |
Anxiety | 90% (18/20) | 85% (17/20) | 55.6% (10/18) | 11.1% (2/18) | < 0.05 | 0 | 44.4% (8/18) | 11.1% (2/18) | < 0.05 |
Depression (EDS) | 85% (17/20) | 85% (17/20) | 58.8% (10/17) | 10% (2/20) | 0.01 | 0 | 52.9% (9/17) | 11.8% (2/17) | < 0.05 |
Symptoms with no improvement
Symptom/problem | % pre-surgery | % post-surgery | % with improvement in frequency post-surgery* | % with worsening of frequency post-surgery* | Frequency P value† | % with onset post-surgery | % with improvement severity post-surgery* | % with worsening of severity post-surgery* | Severity P value† |
---|---|---|---|---|---|---|---|---|---|
Fatigue | 100% | 100% | 35% (7/20) | 10% (2/20) | 0.07 | 0 | 55% (11/20) | 15% (3/20) | 0.10 |
Poor memory | 90% (18/20) | 95% (19/20) | 44.4% (8/18) | 0 | 0.23 | 5% (1/20) | 27.8% (5/18) | 16.7% (3/18) | 1 |
Loss vision | 75% (15/20) | 60% (12/20) | 46.7% (7/15) | 13.3% (2/15) | 0.08 | 0 | 40% (6/15) | 20% (3/15) | 0.17 |
Hands/feet cold/blue | 70% (14/20) | 70% (14/20) | 35.7% (5/14) | 7.1% (1/14) | 0.07 | 0 | 21.4% (3/14) | 7.1% (1/14) | 0.33 |
Difficulty balancing | 80% (16/20) | 70% (14/20) | 68.8% (11/16) | 12.5% (2/16) | 0.10 | 10% (2/20) | 68.8% (11/16) | 6.2% (1/16) | 0.06 |
Difficulty walking | 70% (14/20) | 75% (15/20) | 64.3% (9/14) | 7.1% (1/14) | 0.66 | 15% (3/20) | 64.3% (9/14) | 7.1% (1/14) | 0.32 |
Leg weakness | 70% (14/20) | 75% (15/20) | 57.2% (8/14) | 14.3% (2/14) | 0.63 | 10% (2/20) | 57.2% (8/14) | 7.1% (1/14) | 0.32 |
Dysphagia | 70% (14/20) | 80% (16/20) | 50% (7/14) | 21.4% (3/14) | 0.69 | 15% (3/20) | 28.6% (4/14) | 21.4% (3/14) | 0.69 |
Choking | 35% (7/20) | 45% (9/20) | 28.6% (2/7) | 14.3% (1/7) | 0.71 | 16.7% (3/18) | 28.6% (2/7) | 14.3% (1/7) | 0.65 |
Hearing problems | 70% (14/20) | 65% (13/20) | 35.7% (5/14) | 28.6% (4/14) | 0.63 | 10% (2/20) | 28.6% (4/14) | 21.4% (3/14) | 0.81 |
Urinary frequency | 70% (14/20) | 75% (15/20) | 7.1% (1/14) | 21.4% (3/14) | 0.27 | 5% (1/20) | 14.3% (2/14) | 14.3% (2/14) | 0.67 |
Urinary incontinence | 50% (10/20) | 40% (8/20) | 30% (3/10) | 30% (3/10) | 1 | 0 | 40% (4/10) | 30% (3/10) | 0.79 |
Sexual dysfunction | 40% (8/20) | 35% (7/20) | 25% (2/8) | 12.5% (1/8) | 0.48 | 5% (1/20) | 37.5% (3/8) | 12.5% (1/8) | 1 |