Perioperative outcomes and technical and patient-reported success of rigid occipitocervical fusions in adults: a systematic review and meta-analysis

Purpose: Occipitocervical (OC) fusions are uncommon and challenging surgeries as patients have a wide range of pathologies that could necessitate this procedure. Due to this rarity, limited outcomes data are available for OC fusions. To the authors’ knowledge, this is the first meta-analysis on the topic of OC fusions with a specific focus on the current preference of treatment with rigid constructs. Methods: A literature search of the Embase and PubMed databases was completed from each database’s earliest records to April 23, 2024. Studies were included if they focused on rigid construct methods for OC fusions in adults. 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 (CI). Results: A total of 42 studies, encompassing 1,274 patients, were included in this study. Included patients had a mean age of 57.18 years (CI, 52.21–62.15; I² = 94.47%), with women representing 57.2% (CI, 50.14–64.03; I² = 53%) of the population. Successful bony fusion was found in 96.7% (CI, 92.54–98.59; I² = 0%) of cases, with reoperation occurring in 4.7% (CI, 2.62–8.36; I² = 0%) of patients. Surgical site infection was the most common complication at a rate of 6.97% (CI, 5.19–9.29; I² = 0%), followed by cerebrospinal fluid leak at 2.9% (CI, 1.32–6.36; I² = 0%), instrumentation failure at 2.6% (CI, 1.16–5.71; I² = 0%), vertebral artery injury at 1.6% (CI, 0.74–3.61; I² = 0%), and screw loosening at 1.4% (CI, 0.65–3.16; I² = 0%). Conclusion: Rigid OC fusions have an extremely high likelihood of successful bony fusion and lower complication rates than those previously published, demonstrating a promising current state and future for the procedure.