Pediatric Occipitocervical Arthrodesis

Abstract

Object: Few reports exist on the options and effectiveness of craniocervical stabilization in the pediatric population compared with the adult literature. Traditional options in children include onlay grafting and semi-rigid occipitocervical wiring. Recently, reports on the use of rigid internal fixation devices such as occipitocervical plates and contoured loops have provided excellent results in adults, and their use has often obviated the need for external orthosis. The purpose of this article is to report our experience with both traditional and newer rigid internal fixation methods for occipitocervical fusion in children. Methods: During the past 4.5 years, 14 children (ages 4 months to 16 years) have undergone occipitocervical fusion. Indications for fusion included trauma (n = 4), congenital instability/stenosis (n = 6), postinfectious instability (n = 1) and basilar invagination (n = 3). Techniques using onlay grafting (n = 3) as well as rigid internal fixation using plates (n = 1) and contoured craniocervical titanium loops (n = 10) were used. Postoperative orthosis included halo vests (n = 7), minerva jackets (n = 3), sterno-occipital mandibular immobilizer (n = 1), and a cervical collar (n = 3). Long-term follow-up (range 13–58 months) was available for 13 of the 14 children. Conclusions: While each occipitocervical fusion in pediatric patients requires a customized treatment plan, we believe children older than 12 months of age should be considered candidates for rigid internal fixation methods. The rigidity afforded by this method may eliminate the need for rigid external orthotic support in selected individuals. In our experience, anatomic constraints in children less than 1 year old usually require fusion with more traditional onlay techniques. Long-term follow-up studies are still required to assess the effects of rigid internal fixation in the skeletally immature spine.

Management of Pediatric Congenital Atlantoaxial Dislocation: A Report of 23 Cases from Northern India

“…The investigations required for the diagnosis and treatment of AAD are very well documented [3, 13, 14, 15, 16, 17, 18]. We now follow an algorithm which makes our study more informative and cost effective and does away with unnecessary investigations:…”

“…To our knowledge, there have been only 10 publications [15, 16, 17, 24, 25, 26, 27, 28, 29, 30], comprising about 130 children, that have focused specifically on the problem of surgical stabilization of the upper cervical spine and the CV junction in the pediatric and adolescent population. Also, ours is probably the first publication dealing exclusively with the management of children with congenital AAD and problems arising therefrom in children from a developing country.…”

Noonan Syndrome With Occipito-atlantal Dislocation and Upper Cervical Cord Compression Due to C1 Dysplasia and Basilar Invagination -Case Report-

“…1,2) Recent reports have demonstrated that instrumented internal occipitocervical fixation is a reasonable therapeutic option, even for pediatric patients. 1,2,4,5,11,17) Instrumented internal occipitocervical fixation augments the success rate of arthrodesis with minimal use of halo orthoses in pediatric patients. 4) Rigid internal fixation using screw techniques provides superior biomechanical stability and obviates the need for halo orthoses.…”

“…1,2) However, concerns regarding subaxial spinal biomechanics in children undergoing occipitocervical fixation include acquired instability at caudal levels to the fusion site, abnormal spinal curvature, and growth disturbance of the fused vertebral levels. 17) These concerns are still controversial. 1,2,11) For example, occipitocervical fixation in children resulted in increased lordotic curvature of the cervical spine, but reports over the last decade have come to different conclusions with some studies suggesting that these changes are not significant.…”

Temporary Anterior Cervical Plating in a Child with Traumatic Cervical Ligamentous Instability

“…Usage of instrumentation in young children has been reported, but these were mainly instances of upper cervical spine instrumentation applied posteriorly [2, 16, 17]. A few cases of anterior cervical plate applications in children below the age of 8–10 years have appeared in the literature [3, 18].…”