Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

Helenius, Ilkka; Crawford, Haemish; Sponseller, Paul D.; Odent, Thierry; Bernstein, Robert; Stans, Anthony A.; Hedequist, Daniel; Phillips, Jonathan H.

doi:10.2106/jbjs.n.00503

Cited by 26 publications

(20 citation statements)

References 28 publications

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“…In accordance with previous studies, we have noted that rigid fixation enhances fusion rates. 5 - 7 Like Crostelli et al 30 we have found that rigid adult instrumentation can be used to treat pediatric cervical spine instability. Similarly, the anatomical dimension rather than age is the most decisive factor when planning fixation, although sometimes challenging to perform.…”

Section: Discussionmentioning

confidence: 90%

Instrumented cervical spinal fusions in children: Indications and outcomes

Lastikka

Aarnio

Helenius

2017

Journal of Children's Orthopaedics

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PurposeTo report indications, outcomes and complications of instrumented cervical spinal fusion in a consecutive series of children at major university hospitals.MethodsA retrospective, single surgeon series identified 35 consecutive children with a mean follow-up (FU) of 2.5 years undergoing instrumented cervical spinal fusion between 2005 and 2015.ResultsThe main indications were skeletal dysplasia and trauma associated cervical instability. Surgical complications were observed in 12 (34%) patients with multiple complications in four (11%). Four (11%) children required at least one revision surgery, three for nonunion and one for graft dislodgement. All were fused at FU. Surgical complications were more common in children undergoing occipitocervical (OC) fusion than in those avoiding fusion of the OC junction (60% versus 24%) (p = 0.043). Complications were found significantly more in children operated on under the age of ten years than above (50% versus 18%) (p = 0.004). The risk of complications was not dependent on the indications for surgery (skeletal dysplasia versus trauma) (p = 0.177),ConclusionSkeletal dysplasia associated cervical instability and cervical spine injuries represented the most common indications for instrumented cervical spinal fusion in children. Complications were observed in one-third of these children and 11% required revision surgery for complications. OC spinal fusion and spinal fusion before the age of ten years are associated with higher risk of surgical complications and increased mortality than non-OC fusions and cervical spinal fusions at an older age. We urge surgeons to employ caution to the patient, timing and procedure selection when treating paediatric cervical spine.

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Section: Discussionmentioning

confidence: 90%

Instrumented cervical spinal fusions in children: Indications and outcomes

Lastikka

Aarnio

Helenius

2017

Journal of Children's Orthopaedics

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“…Most studies on the outcomes of cervical spinal fusion in patients with SEDC have included both children and adults or other skeletal dysplasias. 8,10,12 Ain et al 12 retrospectively identified 25 patients age ranging 1.75 to 46.9 years with various skeletal dysplasias who underwent surgery for cervical instability. Of those patients, 4 of 7 SEDC patients were children; ages ranging 21 to 89 months with mean 58 months follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…4,8 Several studies have shown the results of a small number of upper cervical fusions in patients with SEDC. [8][9][10] However these studies included children and adults with many forms of spondyloepiphyseal dysplasia and other skeletal dysplasias. Literature to date has not well-documented the long-term results and complications of this population.…”

mentioning

confidence: 99%

Upper Cervical Fusion in Children With Spondyloepiphyseal Dysplasia Congenita

Abousamra²,

Rogers³

et al. 2017

Journal of Pediatric Orthopaedics

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“…The complications in the screw cohorts, including transient neurological deficit, cerebrospinal fluid leak, kyphotic deformity, infection, and nonunion, appeared to be less severe than those in the wire cohorts, which had complications including death, respiratory compromise, and quadriparesis. However, a few studies reported iatrogenic vertebral artery injury or dural venous sinus injury by applying cervical or occipital screw constructs to the smaller and thinner bone structure [18][19][20] , which might result in mortality. Regarding vertebral artery variations, only 1 patient with bilateral vertebral arteries entering the transverse foramen at the C4 level was observed in this series.…”

Section: Fusion Rates and Complications Related To Fusion Surgery In mentioning

confidence: 99%

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

Watanabe

Hirano

Katsumi

et al. 2017

Spine Surg Relat Res

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Abstract:Purpose: This study aimed to investigate radiographic outcomes after posterior spinal fusion (PSF) for pediatric patients younger than 10 years with upper cervical disorders. Methods: Thirteen patients (mean age at surgery, 5.9 years; range, 1 to 9 years) who underwent PSF with a minimum of 2 years of follow-up (mean, 5.8 years) were included. Diagnoses were atlanto-axial instability due to congenital disorders for 11 patients and atlanto-axial rotatory fixation for 2 patients. The fusion area was occipito-cervical for 7 patients and C1/2 for 6 patients. PSF was performed using rigid screw-rod constructs for 6 patients and conventional techniques for 7 patients. Ten patients required halo immobilization after surgery. Fusion status, perioperative complications, radiographic alignment, and range of motion (ROM) from C2 to C7 were evaluated. Results: Twelve patients successfully achieved bony fusion (fusion rate, 92%), but complications occurred in 5 patients. Regarding radiographic measures (preoperative/postoperative/final follow-up), the mean atlanto-dental interval was significantly reduced (8.0 mm/2.7 mm/3.5 mm) and the C2-7 ROM was increased (from 49.4 degrees to 66.0 degrees) at the final follow-up (both comparisons, p<0.05). Sagittal alignment was unchanged. Conclusion: Use of rigid screw-rod instrumentation in the upper cervical spine with careful radiological evaluation is amenable for pediatric patients younger than 10 years. However, conventional procedures such as wiring fixation with rigid external immobilization are still alternative options for preventing serious neurological and vascular complications.

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Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

Abstract: The nonunion rate is relatively high after patients undergo spinal fusion for C1-C2 instability with nonrigid instrumentation, even if a halo-body jacket is applied. Rigid fixation with screws and rods improves fusion rates.

Cited by 26 publications

References 28 publications

Instrumented cervical spinal fusions in children: Indications and outcomes

Instrumented cervical spinal fusions in children: Indications and outcomes

Upper Cervical Fusion in Children With Spondyloepiphyseal Dysplasia Congenita

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

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