Pediatric Occipitocervical Arthrodesis: A Review of Current Options and Early Evaluation of a Rigid Internal Fixation Device

Schultz, Kurt; Petronio, Joseph; Haid, Regis W.; Rodts, Gerald E.; Erwood, Scott; Alexander, J. Trent; Narad, Christine

doi:10.1097/00006123-199709000-00166

Cited by 22 publications

(33 citation statements)

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“…The clinical outcomes in this series are consistent with observation in experimental models that axons subjected to strain recover rapidly, both anatomically and functionally [30][31][32], and with neurosurgical series where anatomical alignment has been restored, and which show that even profound clinical deficits are recoverable [5,12,14,17,[33][34][35][36][37][38][39][40]. Improvement in pain, bulbar symptoms, ASIA index, Karnofsky index and quality of life assessment support the concept that restoration of the neutral position of the cervical spine and craniospinal junction with a neck brace decreases the deleterious effects of flexion in the setting of erstwhile abnormal movement and anatomical abnormality.…”

Section: Neurological Outcomes After Whiplash Injurysupporting

confidence: 87%

Clinical and Finite Element Analysis of Acute Whiplash

Tannoury¹,

Rihn²,

Wilson³

et al. 2011

TOSPINEJ

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Study Design:A prospective 1-year follow-up study of whiplash patients presenting with neurological signs/or symptoms (WADIII), and whiplash patients with neck pain but no neurologic findings (WADI/II). Objective:We hypothesize that WADI/II and WADIII are distinct entities, with regards to clinical presentation, pathoanatomy, and prognosis.Summary of Background Data: symptoms associated with whiplash injury range from mild neck pain (WADI/II), to injuries associated with neurologic sequellae (WADIII). To date, literature considers whiplash associated disorders (WAD) a single clinical and pathologic entity, with different grades of severity (WADI-IV).Methods: Thirty one subjects were divided into a WADIII study group and a WADI/II comparison group. All subjects underwent H&P, radiographic evaluations, and clinical outcome measures (collected at 3, 6, and 12 months). Statistical analysis was performed (Student T-test, Wilcoxon Signed-Rank test) with significance set at p=0.05. A finite element analysis (FEA) technology (SCOSIA©) was used to predict stresses within the neuraxis.Results: At day 0: Better neurologic assessments, functional performances, and higher quality-of-life measurements were noted in WADI/II compared to WADIII. VAS scores were comparable.At 12 months: Both groups reported improvements in neurologic status and disability symptoms. However functional recovery and quality-of-life measures significantly improved in WADIII, and conversely deteriorated in WADI/II along with notable worsening of pain symptoms. Litigation claims were comparable. FEA predicted higher stress within the neuraxis of WADIII, notably in subjects with preexisting stenosis and odontoid retroflexion. Conclusion:WADI/II and WADIII are distinct entities. Musculoskeletal injury precipitates WADI/II pain symptoms while neuronal stretching leads to WADIII neurologic injuries, which are mostly recoverable.

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Section: Neurological Outcomes After Whiplash Injurysupporting

confidence: 87%

Clinical and Finite Element Analysis of Acute Whiplash

Tannoury¹,

Rihn²,

Wilson³

et al. 2011

TOSPINEJ

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“…7,10,46,73,78,88) In addition to translational atlantoaxial instability, they often cause vertical dislocation of the odontoid process into the posterior fossa, resulting in basilar invagination and impingement of the brainstem between the tip of the odontoid process and the posterior arch of the atlas. 10,88) For such vertical dislocation, occipitocervical fixation with or without anterior removal of the odontoid process is usually performed for decompression of the brainstem and restoration of the anatomical alignment.…”

Section: Congenital/pediatricmentioning

confidence: 99%

“…10,88) For such vertical dislocation, occipitocervical fixation with or without anterior removal of the odontoid process is usually performed for decompression of the brainstem and restoration of the anatomical alignment. 6,73,78,88) The pediatric population will frequently display distinct patterns of fracture and/or ligamentous injury of the CCJ. Os odontoideum, a congenital anomaly (although some authors favor its traumatic origin), is characterized by a small corticated ossicle separated from the base of the odontoid, and is a major cause of atlantoaxial instability in young children.…”

Section: Congenital/pediatricmentioning

confidence: 99%

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

Inamasu

Kim

Klugh

2005

Neurol. Med. Chir.(Tokyo)

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The surgical treatment of craniocervical junction (CCJ) instability has recently undergone significant development and change. Posterior instrumentation surgery has been the mainstay of treatment of CCJ instability, and is the focus of this review. For the treatment of atlantoaxial instability, C1-2 transarticular screw fixation has shown good stability, and has been regarded as the``gold standard'' procedure. Because of potentially hazardous complications including vertebral artery injury, however, C-1 lateral mass-C-2 pedicle screw fixation is gaining popularity. For treatment of atlantooccipital instability, occipitocervical fixation using screw constructs (combined with either rods or plates) has shown more stability than sublaminar wiring techniques, and has been utilized more frequently. Both innovation in material engineering and in vitro biomechanical studies have contributed significantly to the development of more rigid internal fixation devices, and as a result, many patients who would have been treated conservatively with external orthosis are treated nowadays with instrumentation surgery, resulting in earlier ambulation, shortened hospital stay, and earlier recovery into social activities. New surgical techniques and instruments, however, need to stand the test of time to see whether they are free from long-term adverse events. The rapid turnover of new surgical techniques and hardware has made it difficult for less experienced surgeons to keep up with the latest developments. Conventional techniques can be safer and less technically demanding than newer techniques for those who are not familiar with them.

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“…There are a wide variety of possible etiologies for pediatric OC and AA instability, including trauma, Down syndrome, os odontoideum, infection, mucopolysaccharidosis, atlantoaxial rotatory subluxation, juvenile rheumatoid arthritis, tumors, spondyloepiphyseal dysplasia, iatrogenic causes, and others. 4,13,20,30,32,40 It has been shown that trauma is the most common cause of OC and AA instability, with younger children being more likely to sustain upper cervical injuries than older children. 2,7,25,35,36 Because untreated or unrecognized instability may result in neurological injury, surgical fusion of the craniocervical junction is sometimes necessary.…”

mentioning

confidence: 99%

Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children

Kennedy

D’Amico

Youngerman

et al. 2016

Journal of Neurosurgery: Pediatrics

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OBJECT The long-term consequences of atlantoaxial (AA) and occipitocervical (OC) fusion and instrumentation in young children are unknown. Anecdotal reports have raised concerns regarding altered growth and alignment of the cervical spine after surgical intervention. The purpose of this study was to determine the long-term effects of these surgeries on the growth and alignment of the maturing spine. METHODS A multiinstitutional retrospective chart review was conducted for patients less than or equal to 6 years of age who underwent OC or AA fusion with rigid instrumentation at 9 participating centers. All patients had at least 3 years of clinical and radiographic follow-up data and radiographically confirmed fusion. Preoperative, immediate postoperative, and most recent follow-up radiographs and/or CT scans were evaluated to assess changes in spinal growth and alignment. RESULTS Forty children (9 who underwent AA fusion and 31 who underwent OC fusion) were included in the study (mean follow-up duration 56 months). The mean vertical growth over the fused levels in the AA fusion patients represented 30% of the growth of the cervical spine (range 10%–50%). Three different vertical growth patterns of the fusion construct developed among the 31 OC fusion patients during the follow-up period: 1) 16 patients had substantial growth (13%–46% of the total growth of the cervical spine); 2) 9 patients had no meaningful growth; and 3) 6 patients, most of whom presented with a distracted atlantooccipital dislocation, had a decrease in the height of the fused levels (range 7–23 mm). Regarding spinal alignment, 85% (34/40) of the patients had good alignment at follow-up, with straight or mildly lordotic cervical curvatures. In 1 AA fusion patient (11%) and 5 OC fusion patients (16%), we observed new hyperlordosis (range 43°–62°). There were no cases of new kyphosis or swan-neck deformity, evidence of subaxial instability, or unintended subaxial fusion. No preoperative predictors of these growth patterns or alignment were evident. CONCLUSIONS These results demonstrate that most young children undergoing AA and OC fusion with rigid internal fixation continue to have good cervical alignment and continued growth within the fused levels during a prolonged follow-up period. However, some variability in vertical growth and alignment exists, highlighting the need to continue close long-term follow-up.

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Pediatric Occipitocervical Arthrodesis: A Review of Current Options and Early Evaluation of a Rigid Internal Fixation Device

Cited by 22 publications

References 0 publications

Clinical and Finite Element Analysis of Acute Whiplash

Clinical and Finite Element Analysis of Acute Whiplash

Posterior Instrumentation Surgery for Craniocervical Junction Instabilities: an Update

Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children

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