Two-Stage Approach for Unstable Pediatric Craniocervical Junction Anomalies with a Halo Vest and Delayed Occipitocervical Fusion: Technical Note, Case Series, and Literature Review

Cranio-cervical decompression associated with non-instrumented occipito-C2 fusion in children with mucopolysaccharidoses: Report of twenty-one cases

“…The realization of the cranial-C2 fusion with the halo-vest seems satisfactory to us with a successful arthrodesis in all patients and the least risk of perioperative complications. The result of the 2-stage procedure was considered optimal in all 21 cases in our series, as well as that of Tirado-Caballero J et al [3] . Several limitations to the present study need to be addressed.…”

“…The presence of neurological signs or myelopathies on the MRI was an absolute indication for surgery [ 18 , 19 ]. For other authors, the presence of neck pain or torticollis, signs of instability of the CCJ, was also an indication for surgery [ 3 , 20 ]. In our series, the indication for surgery was posed in the presence of a neurological deficit, which was associated with signs of instability and spinal cord compression on MRI.…”

“…In our series, the indication for surgery was posed in the presence of a neurological deficit, which was associated with signs of instability and spinal cord compression on MRI. Intraoperative reduction employing a single surgical approach has been preferred by some authors [ [21] , [22] , [23] ], and several techniques have been applied for this purpose in pediatric patients [ 3 , 21 , 23 ]. Cranio-C2 stabilization with internal osteosynthesis material can interfere with placement of the bone graft for occipito-cervical fusion.…”

“…The progressive traction allows for emergency C0-C1-C2 decoaptation [ 3 , 42 , 43 ], which clinically translates into an improvement in the neurological state immediately after placement of the Halo-vest. In our series, 8 patients had a spectacular improvement in the neurological state 3 to 6 days after this first stage of care with a significant gain for the mJOA score and Goel grade.…”

“…Posterior spinal cord decompression and cranio-C2 arthrodesis often raise the problem of fixation in children with MPS. The technique of two-stage approach for unstable pediatric CCJ anomalies with a cranial halo-cast and delayed occipitocervical fusion has been barely studied in the pediatric population [3] .…”