Pediatric occipitocervical fixation: radiographic criteria, surgical technique, and clinical outcomes based on experience of a single surgeon

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>If left untreated, occipitocervical (OC) instability may lead to serious neurological injury or death. Open internal fixation is often necessary to protect the neurovascular elements. This study reviews the etiologies for pediatric OC instability, analyzes the radiographic criteria for surgical intervention, discusses surgical fixation techniques, and evaluates long-term postoperative outcomes based on a single surgeon's experience.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>The charts of all patients &lt; 18 years old who underwent internal OC fixation conducted by the senior author were retrospectively reviewed. Forty consecutive patients were identified for analysis. Patient demographic data, OC junction pathology, radiological diagnostic tools, surgical indications, and outcomes are reported.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The study population consisted of 20 boys and 20 girls, with a mean age of 7.3 years. Trauma (45% [n = 18]) was the most common cause of instability, followed by congenital etiologies (37.5% [n = 15]). The condyle-C1 interval had a diagnostic sensitivity of 100% for atlantooccipital dislocation. The median number of fixated segments was 5 (occiput–C4). Structural bone grafts were used in all patients. Postsurgical neurological improvement was seen in 88.2% (15/17) of patients with chronic myelopathy and in 25% (1/4) of patients with acute myelopathy. Preoperatively, 42.5% (17/40) of patients were neurologically intact and remained unchanged at last follow-up, 42.5% (17/40) had neurological improvement, 12.5% (5/40) remained unchanged, and 2.5% (1/40) deteriorated. All patients had successful fusion at 1-year follow-up. The complication rate was 7.5% (3/40), including 1 case of vertebral artery injury.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Occipitocervical fixation is safe in children and provides immediate immobilization, with excellent survival and arthrodesis rates. Of the radiographic tools evaluated, the condyle-C1 interval was the most predictive of atlantooccipital dislocation.</jats:p></jats:sec>

Spinal instrumentation in infants, children, and adolescents: a review

“…66 The sublaminar wire method, nevertheless, remains a salvage method to obtain internal support for fusion. 76,97,116 Pedicle Screws. Unlike in the thoracic and lumbar spine, subaxial cervical pedicle screws are not widely utilized because of the high risk to adjacent neurovascular structures involved in cannulating the cervical pedicles.…”

Patient-reported outcomes of occipitocervical and atlantoaxial fusions in children

“…The ASIA grade has been previously used to define the neurological status in patients undergoing occipitocervical fusion. 18,21,26 Although this scale is more appropriate for patients who have sustained a spinal cord injury, it does provide a standardized tool to evaluate neurological deficits for these patients. The instruments used in this study were not disease specific and possibly did not address the specific problems associated with occipitocervical fusion.…”

Surgical Management of Spinal Disorders in People with Mucopolysaccharidoses

“…[28]. Several operative methods have been introduced for atlantoaxial/occipito-cervical fixation in patients with MPS, namely, in situ fusion using a halo-vest, cables or wires, transarticular screws, or laminar screws [21,[31][32][33]. The surgical technique is selected depending on the patient's age and anatomical vertebral size, and the surgeon's preference.…”