Anterior approach to the subaxial cervical spine in children: a brief review

Baron, Eli M.; Loftus, Christopher M.; Vaccaro, Alexander R.; Dominique, Devanand A.

doi:10.3171/foc.2006.20.2.5

Cited by 14 publications

(8 citation statements)

References 35 publications

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“…Although traumatic OC destabilization occurs in all age groups, young children (< 8 years) are especially vulnerable due to hypermobility of the CVJ and increased head-to-torso size and weight ratios. 7,25,27,39,48 Although in the present study the mean age of patients with acute traumatic injuries (6.2 ± 4.1 years; range 2-16 years) differed from that of those with all other chronic pathologies (7.7 ± 4.7 years; range 7 months to 16 years), this difference was not statistically significant (p = 0.3). Both traumatic 17,24,26,48 and congenital etiologies 12,20,25,44,52,57 are frequently reported as the most common causes of OC instability in children.…”

Section: Etiology Of Oc Instabilitycontrasting

confidence: 71%

“…The incorporation of structural grafts strengthens the construct and improves arthrodesis rates. 3,4,6,7,17,40,57 However, the most appropriate fixation strategy must be tailored to each patient; surgeons should consider the underlying pathology, size of the spinal osseous structures, any anatomical variations, and extent of pathology. The size of the bone at sites of fixation is most often dictated by the patient's age and any comorbid congenital syndrome.…”

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confidence: 99%

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Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

Martinez-del-Campo¹,

Turner²,

Rangel-Castilla³

et al. 2016

PED

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OBJECTIVE If left untreated, occipitocervical (OC) instability may lead to serious neurological injury or death. Open internal fixation is often necessary to protect the neurovascular elements. This study reviews the etiologies for pediatric OC instability, analyzes the radiographic criteria for surgical intervention, discusses surgical fixation techniques, and evaluates long-term postoperative outcomes based on a single surgeon's experience. METHODS The charts of all patients < 18 years old who underwent internal OC fixation conducted by the senior author were retrospectively reviewed. Forty consecutive patients were identified for analysis. Patient demographic data, OC junction pathology, radiological diagnostic tools, surgical indications, and outcomes are reported. RESULTS The study population consisted of 20 boys and 20 girls, with a mean age of 7.3 years. Trauma (45% [n = 18]) was the most common cause of instability, followed by congenital etiologies (37.5% [n = 15]). The condyle-C1 interval had a diagnostic sensitivity of 100% for atlantooccipital dislocation. The median number of fixated segments was 5 (occiput–C4). Structural bone grafts were used in all patients. Postsurgical neurological improvement was seen in 88.2% (15/17) of patients with chronic myelopathy and in 25% (1/4) of patients with acute myelopathy. Preoperatively, 42.5% (17/40) of patients were neurologically intact and remained unchanged at last follow-up, 42.5% (17/40) had neurological improvement, 12.5% (5/40) remained unchanged, and 2.5% (1/40) deteriorated. All patients had successful fusion at 1-year follow-up. The complication rate was 7.5% (3/40), including 1 case of vertebral artery injury. CONCLUSIONS Occipitocervical fixation is safe in children and provides immediate immobilization, with excellent survival and arthrodesis rates. Of the radiographic tools evaluated, the condyle-C1 interval was the most predictive of atlantooccipital dislocation.

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Section: Etiology Of Oc Instabilitycontrasting

confidence: 71%

mentioning

confidence: 99%

Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

Martinez-del-Campo¹,

Turner²,

Rangel-Castilla³

et al. 2016

PED

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“…8,9,[12][13][14]16,17,19,21,25,32 One type of upper cervical spine injury, atlantooccipital dislocation (AOD), is a severe injury associated with high mortality rates. 1,2,11,12,[16][17][18][19][20]22,24 In postmortem examinations, evidence of AOD is present in 20%-31% of deaths due to cervical spine injuries. 6 In recent decades, improvements in emergency management, transport, and recognition of AOD have resulted in higher survival rates.…”

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confidence: 99%

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Martinez-del-Campo

Kalb

Soriano-Baron

et al. 2016

SPI

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OBJECT Atlantooccipital dislocation (AOD) in adults cannot be diagnosed with adequate specificity and sensitivity using only CT or plain radiography, and the spine literature offers no guidelines. In children, the most sensitive and specific radiographic measurement for the diagnosis of AOD is the CT-based occipital condyle–C1 interval (CCI). The goal of the current study was to identify the normal CCI in healthy adults and compare it with the CCI in adults with AOD to establish a highly sensitive and specific cutoff value for the neuroimaging diagnosis of AOD. METHODS A total of 81 patients, 59 without AOD and 22 with AOD, were included in this study. Measurements obtained from thin-slice CT scans of the craniovertebral joint to assess atlantooccipital dislocation included the CCI, condylar sum, the Wholey and Harris intervals, Powers and Sun ratios, Wackenheim line, and Lee X-lines. RESULTS The group of patients without AOD included 30 men (50.8%) and 29 women (49.2%) with a mean age of 42.4 ± 16 years (range 19–87 years). The group of patients with AOD included 10 men (45.5%) and 12 women (54.5%) with a mean age of 38.2 ± 9.7 years (range 20–56 years). Interrater reliabilities within a 95% CI were all greater than 0.98 for CCI measurements. A total of 1296 measurements of the CCI were made in 81 patients. The mean CCI for non-AOD patients was 0.89 ± 0.12 mm, the single largest CCI measurement was 1.4 mm, and the largest mean for either right or left CCI was 1.2 mm. The mean condylar sum was 1.8 ± 0.2 mm, and the largest condylar sum value was 2.2 mm. Linear regression with age predicted an increase in CCI of 0.001 mm/year (p < 0.05). The mean CCI in AOD patients was 3.35 ± 0.18 mm (range 1.5 mm–6.4 mm). The shortest single CCI measurements in the AOD patients were 1.1 mm and 1.2 mm. The mean condylar sum for all 22 AOD patients was 6.7 ± 2.7 mm and the shortest condylar sums were 3.0 mm. Cutoff values for AOD were set at 1.5 mm for the CCI and 3.0 mm for the condylar sum, both with a sensitivity of 1 and false-negative rate of 0. Sensitivity for the Powers, Wholey, Harris, Sun, Wackenheim, and Lee criteria were determined to be 0.55, 0.46, 0.27, 0.23, 0.41, and 0.41, respectively. CONCLUSIONS The CCI is shorter in adult patients as opposed to the pediatric population. The revised CCI (1.5 mm) and condylar sum (3.0 mm) cutoff values have the highest sensitivity and specificity for the diagnosis of AOD in the adult population.

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“…15,16,26,34 In moving from wiring constructs to rigid cervical fixation instrumentation in the pediatric population, the aim was to achieve increased construct stability, increased cervical fusion rates, reduced graft extrusion rates, and a decreased need for halo immobilization. 2,4,23,32 Modern spinal fixation instrumentation has been well established for pediatric spine surgeries involving the thoracic and lumbar spine; however, there are no size-specific implants recommended for the pediatric cervical spine. 3,5,[22][23][24]41,48,50,51 Hedequist and colleagues 23 have recently studied the feasibility of modern cervical spine instrumentation in children when rigid fixation was required for cervical stabilization and fusion.…”

Section: Discussionmentioning

confidence: 99%

Circumferential fixation with craniofacial miniplates for a cervical spine injury in a child

Patel¹,

Hazzard²,

Ackerman³

et al. 2009

PED

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Unstable pediatric cervical spine injuries present significant challenges in terms of fixation. Given the smaller cervical vertebral bodies in the preschool-aged population, commercially available pediatric cervical fixation instrumentation may be unsuitable because of the inappropriately large size of the screws and plates. The authors describe a 2-year-old girl who sustained an unstable C6–7 distraction injury during a motor vehicle accident. Because of the small size of her vertebral bodies, standard cervical spine instrumentation was not feasible, and posterior wiring alone was believed to be insufficient because of the complete distraction of all 3 spinal columns. The patient was taken to the operating room where craniofacial plates with an inherent locking mechanism were used to circumferentially stabilize the cervical spine. Follow-up examination 6 months postoperatively demonstrated stable cervical spine alignment and fusion with no evidence of the failure of either the anterior or posterior hardware. The use of craniofacial miniplates with an intrinsic locking mechanism represents a superior alternative for both anterior and posterior cervical fixations when spinal instrumentation is needed in the pediatric age group.

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Anterior approach to the subaxial cervical spine in children: a brief review

Cited by 14 publications

References 35 publications

Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

Computed tomography parameters for atlantooccipital dislocation in adult patients: the occipital condyle–C1 interval

Circumferential fixation with craniofacial miniplates for a cervical spine injury in a child

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