Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Hedequist, Daniel

doi:10.1007/s11420-014-9398-4

Cited by 11 publications

(10 citation statements)

References 28 publications

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“…A few previous studies have evaluated certain anatomical parameters on magnetic resonance imaging (MRI), such as sagittal diameter and lateralization of the cervical spinal cord in healthy volunteers and patients undergoing surgery with cervical conditions such as cervical kyphosis or spondylotic myelopathy. 4,[11][12][13][14][15] Nonetheless, few studies have focused on the preoperative assessment of the spinal cord safety margins in the axis.…”

mentioning

confidence: 99%

Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation

Chiapparelli

Bowen²,

Okano³

et al. 2021

Spine

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Study Design. Retrospective observational study.Objective. The aim of this study was to investigate the spinal cord safety margins for C2 instrumentation. Summary of Background Data. Intraoperative spinal cord injury during C2 spine surgery is a rare, but potentially lifethreatening complication. Preoperative planning for C2 instrumentation mainly focuses on C2 pedicle bony dimensions on CT and the vertebral artery location and few studies have evaluated C2 spinal cord safety margins. Methods. We measured two distances in C2 bilaterally: C2 pedicle to dura distance (P-D), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and the dural sac, and C2 pedicle to spinal cord (P-SC), defined as a transverse line that measured the shortest distance between the medial wall of the C2 pedicle and spinal cord. We defined the distances >4 mm as safe for instrumentation. Result. A total of 146 patients (mean age 71.2, 50.7% female) were included. The average distances were 5.5 mm for C2 left PD, 5.9 mm for C2 right P-D, 10.1 mm for C2 left P-SC, and 10.6 mm for C2 right P-SC. Twenty-eight (21.4%) patients had C2 P-D distances <4 mm and of those two (7%) patients had distances <2 mm. There were more female patients with C2 P-D distances under 4 mm compared to males. No patient had C2 P-SC distances <4 mm. Conclusion. We demonstrated that around 20% of patients had C2 P-D distance <4 mm, but no patient had C2 P-SC distance <4 mm. Since a lateral misplacement can lead to a potentially fatal vertebral artery injury, medial screw trajectory is recom-mended for C2 pedicle instrumentation with consideration of these safety margins.

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mentioning

confidence: 99%

Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation

Chiapparelli

Bowen²,

Okano³

et al. 2021

Spine

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“…A study by Odent et al found that patients with odontoid fractures who were treated with a halo device (12 patients) had a better overall recovery and experienced fewer complications compared to those who were managed operatively (three patients) [ 23 ]. Many other studies have found similar results, highlighting the principle that external fixation remains the preferred modality of treatment for pediatric odontoid injuries [ 24 - 26 ]. Of the 10 patients in our study who were stabilized with cervical orthoses, Minerva vest, and Miami J collar braces were utilized.…”

Section: Discussionmentioning

confidence: 57%

“…In cases of severe cervical spine fractures or dislocations, unstable injuries, or progressive deformity, surgical interventions via internal fixation or surgical decompression are warranted as definitive treatment [ 14 , 19 , 25 ]. The innate pediatric cervical anatomy may pose a greater challenge for pin or screw placement when compared to the adult spine [ 26 ]. However, the advent of technological advancements in preoperative and intraoperative imaging has assisted clinicians in discerning the anatomical variations in each patient and ultimately guiding operative management [ 18 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…The innate pediatric cervical anatomy may pose a greater challenge for pin or screw placement when compared to the adult spine [ 26 ]. However, the advent of technological advancements in preoperative and intraoperative imaging has assisted clinicians in discerning the anatomical variations in each patient and ultimately guiding operative management [ 18 , 26 ]. Operative management in pediatric upper cervical spine patients differs based on the level of injury.…”

Section: Discussionmentioning

confidence: 99%

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Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Hasan¹,

Waheed²,

Suhrawardy³

et al. 2022

Cureus

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Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson’s chi-squared or Fisher’s exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p <0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p =0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.

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“…[1][2][3][4] Throughout the past 2 decades, rigid fixation techniques have overtaken semirigid techniques for stabilization of craniocervical and subaxial cervical instability, with improved outcomes. [5][6][7] However, large, multicenter, or multidisciplinary studies investigating the surgical outcomes, clinical and radiographic criteria for instability, or the nonoperative management of these patients have been very limited. [8][9][10][11] Originally developed by the RAND Corporation during the Cold War, the Delphi method was first used to predict which American industrial targets might be bombed by the Soviet Union and to determine the quantity of bombs required to damage US munitions.…”

mentioning

confidence: 99%

Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study

Dastagirzada

Alexiades

Kurland

et al. 2023

Journal of Neurosurgery: Pediatrics

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OBJECTIVE Cervical spine disorders in children are relatively uncommon; therefore, paradigms for surgical and nonsurgical clinical management are not well established. The purpose of this study was to bring together an international, multidisciplinary group of pediatric cervical spine experts to build consensus via a modified Delphi approach regarding the clinical management of children with cervical spine disorders and those undergoing cervical spine stabilization surgery. METHODS A modified Delphi method was used to identify consensus statements for the management of children with cervical spine disorders requiring stabilization. A survey of current practices, supplemented by a literature review, was electronically distributed to 17 neurosurgeons and orthopedic surgeons experienced with the clinical management of pediatric cervical spine disorders. Subsequently, 52 summary statements were formulated and distributed to the group. Statements that reached near consensus or that were of particular interest were then discussed during an in-person meeting to attain further consensus. Consensus was defined as ≥ 80% agreement on a 4-point Likert scale (strongly agree, agree, disagree, strongly disagree). RESULTS Forty-five consensus-driven statements were identified, with all participants willing to incorporate them into their practice. For children with cervical spine disorders and/or stabilization, consensus statements were divided into the following categories: A) preoperative planning (12 statements); B) radiographic thresholds of instability (4); C) intraoperative/perioperative management (15); D) postoperative care (11); and E) nonoperative management (3). Several important statements reaching consensus included the following recommendations: 1) to obtain pre-positioning baseline signals with intraoperative neuromonitoring; 2) to use rigid instrumentation when technically feasible; 3) to provide postoperative external immobilization for 6–12 weeks with a rigid cervical collar rather than halo vest immobilization; and 4) to continue clinical postoperative follow-up at least until anatomical cervical spine maturity was reached. In addition, preoperative radiographic thresholds for instability that reached consensus included the following: 1) translational motion ≥ 5 mm at C1–2 (excluding patients with Down syndrome) or ≥ 4 mm in the subaxial spine; 2) dynamic angulation in the subaxial spine ≥ 10°; and 3) abnormal motion and T2 signal change on MRI seen at the same level. CONCLUSIONS In this study, the authors have demonstrated that a multidisciplinary, international group of pediatric cervical spine experts was able to reach consensus on 45 statements regarding the management of pediatric cervical spine disorders and stabilization. Further study is required to determine if implementation of these practices can lead to reduced complications and improved outcomes for children.

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Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Cited by 11 publications

References 28 publications

Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation

Spinal Cord Medial Safe Zone for C2 Pedicle Instrumentation

Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center

Developing consensus for the management of pediatric cervical spine disorders and stabilization: a modified Delphi study

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