Complications and outcomes of posterior fusion in children with atlantoaxial instability

Tauchi, Ryoji; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Ken‐ichi; Muramoto, Akio; Matsui, Hiroki; Kato, Fumihiko; Yukawa, Yasutsugu; Sato, Koji; Kanemura, Tokumi; Yoshihara, Hisatake; Kamiya, Mitsuhiro; Matsuyama, Yukihiro; Ishiguro, Naoki

doi:10.1007/s00586-011-2083-0

Cited by 33 publications

(32 citation statements)

References 34 publications

(50 reference statements)

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“…Several articles stated that the dimensions of the cervical canal had reached adult size by 5-6 years of age [32,33]. Several studies detected that cervical lordosis increased after occipitocervical fusion [17,34,35]. Nevertheless, in the case of short-segment fixation at the C1-C2 level, Gluf and Brockmeyer [24] reported that the C1-C2 transarticular screw technique did not induce growth deformity in the sagittal or coronal plane.…”

Section: Discussionmentioning

confidence: 99%

“…Anderson et al [36] reported an increase in lordosis in pediatric patients undergoing C1-C2 transarticular screw fixation, although this was not statistically significant. Tauchi et al [35] showed that the height of the disc decreased at the fused level, but no different from the vertebra between the fused and nonfused levels. In our study, 16 patients were followed up for a period of 6-80 months, with no crankshaft phenomenon having been identified by the final visit.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Application of a Revised Screw Technique via the C1 Posterior Arch and Lateral Mass in the Pediatric Population

Tan

et al. 2013

Pediatr Neurosurg

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Objective: Pediatric patients with insufficient height (≤4 mm) of the C1 posterior arch may restrict atlas screw placement via the posterior arch and lateral mass (PALM). For these patients, we modified this technique, called the ‘pedicle exposure technique' (PET). We aimed to analyze the clinical feasibility and safety of the PET in the pediatric population. Methods: Twenty pediatric patients with atlantoaxial instability (AAI) were enrolled in this study. The average C1 posterior arch was 3.1 (2.5-3.9) mm on CT scan. All patients underwent the C1 PET and C2 pedicle screw fixation. The imaging was performed to evaluate the accuracy of screw placement and bony fusion. Results: Forty screws were inserted via C1 PALM using the PET. Venous plexus bleeding occurred in 1 patient and the internal wall of the C1 lateral mass was perforated in 1 patient. There were no perioperative neurological deficits or vertebral artery injury. Follow-up was performed in all 20 cases over a period ranging from 6 to 80 months. Bony union was seen within 3-6 months. At the final follow-up visit, 14 patients had experienced an improvement, while 6 had complete resolution of their neck pain. Myelopathy symptoms were improved in 9 patients with spinal compression. Conclusion: The PET is an effective alternative for pediatric AAI when the height of the C1 posterior arch is <4 mm. Because of the higher screw entry point through the C1 posterior arch, there is effective biomechanical stability and less irritation of the venous plexus and C2 nerve root.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Application of a Revised Screw Technique via the C1 Posterior Arch and Lateral Mass in the Pediatric Population

Tan

et al. 2013

Pediatr Neurosurg

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“…1,2,5,7,10,13,14,16,17,[23][24][25] Patients undergoing spinal arthrodesis are at significant risk for developing complications and having unplanned readmissions and/ or reoperations. These clinical outcomes are undesirable for patients, physicians, and the health care system in general, as they can result in increased cost and decreased quality of life.…”

Section: Neurosurg Focus 43 (4):e7 2017mentioning

confidence: 99%

“…patients 1,2,7,16,17,[23][24][25] or a single complication, 5,10,[13][14][15] while others have been limited to single centers 5,7,9,10 or to the adult population. 7,18,20,21 Few studies have provided a comprehensive description of patient characteristics, operative factors, and comorbidities on short-term morbidity and mortality after spinal arthrodesis in children.…”

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confidence: 99%

Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis

Abu-Bonsrah¹,

Goodwin

Ortega

et al. 2017

Neurosurgical Focus

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OBJECTIVESpinal arthrodesis is routinely performed in the pediatric population. However, there is limited information on the short-term outcomes of pediatric patients who have undergone spine fusion. Thus, the authors conducted a retrospective review of the Pediatric National Surgical Quality Improvement Program (NSQIP) database to determine the short-term mortality, complication, reoperation, and readmission rates of pediatric patients who underwent spinal arthrodesis for all indications.METHODSThe Pediatric NSQIP database was queried for all patients who underwent spinal arthrodesis between 2012 and 2014. Patient demographics, comorbidities, body mass index, American Society of Anesthesiologists classification, and operative time were abstracted. Short-term mortality, reoperation, and readmission rates and complications were also noted. Univariate and multivariate analyses were performed to delineate patient risk factors that influence short-term mortality, complications, reoperation, and readmission rates.RESULTSA total of 4420 pediatric patients who underwent spinal fusion were identified. Common indications for surgical intervention included acquired/idiopathic scoliosis or kyphoscoliosis (71.2%) and genetic/syndromic scoliosis (10.7%). The mean patient age was 13.7 ± 2.9 years, and 70% of patients were female. The overall 30-day mortality was 0.14%. Multivariate analysis showed that female sex and pulmonary comorbidities significantly increased the odds of reoperation, with odds ratios of 1.43 and 1.78, respectively.CONCLUSIONSIn the NSQIP database for pediatric patients undergoing spinal arthrodesis for all causes, there was a 3.6% unplanned reoperation rate, a 3.96% unplanned readmission rate, and a 9.0% complication rate. This analysis provides data for risk stratification of pediatric patients undergoing spinal arthrodesis, allowing for optimized care.

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“…138 Based on our review of the literature, 23 years passed before there was another published article regarding OCF using allograft in children following Koop's publication, and 17 years passed before another article described allograft use for PCF in children following Stabler's article. 11,82,138,140 While there was a dearth of publications related to the use of allograft in pediatric cervical spine fusions for the 2 decades that followed the early failures reported in the 1980s, there has been a resurgence in interest over the most recent decade corresponding to the widespread use of rigid internal fixation techniques and the availability of BMP. 56,69,73,78,88,151 Emboldened by the greater fusion rates associated with screw-based constructs, with or without the use of BMP, there has been a sharp rise in publications describing OCF and PCF in children and adults.…”

Section: Publication Biasmentioning

confidence: 99%

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

Reintjes

Amankwah

Rodríguez

et al. 2016

PED

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OBJECT Fusion rates are high for children undergoing posterior cervical fusion (PCF) and occipito-cervical fusion (OCF). Autologous bone has been widely used as the graft material of choice, despite the risk of donor-site morbidity associated with harvesting the bone, possibly because very low fusion rates were reported with posterior allograft cervical fusions in children several decades ago. Higher overall fusion rates using allograft in adults, associated with improvements in internal fixation techniques and the availability of osteoinductive substances such as bone morphogenetic protein (BMP), have led to heightened enthusiasm for the use of bank bone during pediatric PCF. A systematic review was performed to study factors associated with successful bone fusion, including the type of bone graft used. METHODS The authors performed a comprehensive PubMed search of English-language articles pertaining to PCF and OCF in patients less than 18 years old. Of the 561 abstracts selected, 148 articles were reviewed, resulting in 60 articles that had sufficient detail to be included in the analysis. A meta-regression analysis was performed to determine if and how age, fusion technique, levels fused, fusion substrate, BMP use, postoperative bracing, and radiographic fusion criteria were related to the pooled prevalence estimates. A systematic review of the literature was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. RESULTS A total of 604 patients met the specific inclusion and exclusion criteria. The overall fusion rate was 93%, with a mean age of 9.3 years and mean follow-up of 38.7 months. A total of 539 patients had fusion with autograft (94% fusion rate) and 65 patients with allograft (80% fusion rate). Multivariate meta-regression analysis showed that higher fusion rates were associated with OCF compared with fusions that excluded the occiput (p < 0.001), with the use of autograft instead of allograft (p < 0.001), and with the use of CT to define fusion instead of plain radiography alone. The type of internal fixation, the use of BMP, patient age, and the duration of follow-up were not found to be associated with fusion rates in the multivariate analysis. CONCLUSIONS Fusion rates for PCF are high, with higher rates of fusion seen when autograft is used as the bone substrate and when the occiput is included in the fusion construct. Further study of the use of allograft as a viable alternative to autograft bone fusion is warranted because limited data are available regarding the use of allograft in combination with more rigid internal fixation techniques and osteoinductive substances, both of which may enhance fusion rates with allograft.

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Complications and outcomes of posterior fusion in children with atlantoaxial instability

Cited by 33 publications

References 34 publications

Clinical Application of a Revised Screw Technique via the C1 Posterior Arch and Lateral Mass in the Pediatric Population

Clinical Application of a Revised Screw Technique via the C1 Posterior Arch and Lateral Mass in the Pediatric Population

Risk factors associated with short-term complications and mortality after pediatric spinal arthrodesis

Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rates

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