Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years

Watanabe, Kei; Hirano, Tôru; Katsumi, Keiichi; Ohashi, Masayuki; Shoji, Hirokazu; Hara, Kazuhiro; Ito, Takui; Endo, Naoto

doi:10.22603/ssrr.1.2016-0013

Cited by 3 publications

(1 citation statement)

References 32 publications

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“…Radiographic studies have been conducted to evaluate the instability of the upper cervical spine in young patients with Down syndrome and to predict the appearance of future symptoms, but no consensus has yet been obtained. 11,12 The present case highlights that upper cervical instability due to Down syndrome may cause rapid spinal cord injury.…”

Section: Discussionmentioning

confidence: 76%

Posterior occipitocervical instrumented fusion for atlantoaxial instability in a 27-month-old child with Down syndrome: illustrative case

Ohba

Oda

Tanaka

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUND Upper cervical spine instability is one of the most serious orthopedic problems in patients with Down syndrome. Despite the recent advancement of instrumentation techniques, occipitocervical fusion remains technically challenging in the very young pediatric population with small and fragile osseous elements. OBSERVATIONS A 27-month-old boy with Down syndrome was urgently transported to the authors’ hospital because of difficulty in standing and sitting, weakness in the upper limbs, and respiratory distress. Radiographs showed os odontoideum, irreducible atlantoaxial dislocation, and substantial spinal cord compression. Emergency posterior occipitoaxial fixation was performed using O-arm navigation. Improvement in the motor paralysis of the upper left limb was observed from the early postoperative period, but revision surgery was needed 14 days after surgery because of surgical site infection. The patient showed modest but substantial neurological improvement 1 year after the surgery. LESSONS There are several clinical implications of the present case. It warns that Down syndrome in the very young pediatric population may lead to rapid progression of spinal cord injury and life crisis. This 27-month-old patient represents the youngest case of atlantoaxial instability in a patient with Down syndrome. O-arm navigation is useful for inserting screws into very thin pedicles.

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Section: Discussionmentioning

confidence: 76%

Posterior occipitocervical instrumented fusion for atlantoaxial instability in a 27-month-old child with Down syndrome: illustrative case

Ohba

Oda

Tanaka

et al. 2021

Journal of Neurosurgery: Case Lessons

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show abstract

Verletzungen der kindlichen Wirbelsäule

Wöß¹,

Kathrein²

2022

Orthopädie Und Unfallchirurgie

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Transpharyngeal closed reduction displacement of the first cervical vertebra in children

Wan

Минасов

Yakupova

et al. 2022

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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BACKGROUND: Currently, the treatment of children with atlantoaxial rotational block has no standard protocol. The proposed conservative methods are difficult and require long-term hospitalization, whereas surgical treatment is associated with a risk of complications. AIM: This study aimed to develop and evaluate the effectiveness of the transpharyngeal closed reduction method for first cervical vertebral displacement in children. MATERIALS AND METHODS: The study presents the analysis results of clinical cases of 46 children with atlantoaxial rotational fixation with types III subluxations by Fielding and Hawkins the CI transpharyngeal closed reduction method. The average age of the patients was 4.5 2.6 years. The time of admission of patients after the disease onset varied from 1 to 30 days. The reduction technique consisted of the following elements: 1. A bracket is installed for traction behind the skull along the axis; 2. The surgeon pulls the bracket along the axis, while using the index finger of the other hand in the oropharynx fixes the anterior arch of the atlas, creating a fulcrum; 3. Rotational displacement of the atlas is eliminated by rotational movements with simultaneous traction along the axis; and 4. The anatomical position of the atlas and axis is controlled by an X-ray image intensifier. RESULTS: Only in one case of recurrent dislocation was noted after 4 days. The efficiency of primary reduction was 97.8%. Pain syndrome on the visual analog scale was reduced by 62.3%. Neurological deficit recurrence was not noted. The average bed-day was 2.5 1.3 days. CONCLUSION: Transpharyngeal closed reduction method for first cervical vertebral displacement in children of the younger age group is effective for atlantoaxial rotational fixation treatment in early admitted patients, which determines the prospects for its wider application in the practice of specialized hospitals.

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Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years

Cited by 3 publications

References 32 publications

Posterior occipitocervical instrumented fusion for atlantoaxial instability in a 27-month-old child with Down syndrome: illustrative case

Posterior occipitocervical instrumented fusion for atlantoaxial instability in a 27-month-old child with Down syndrome: illustrative case

Verletzungen der kindlichen Wirbelsäule

Transpharyngeal closed reduction displacement of the first cervical vertebra in children

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