Instrumented arthrodesis for non-traumatic craniocervical instability in very young children

M. B. Janjua, Steven W. Hwang, Amer F. Samdani, Joshua M. Pahys, Mhd-Ali - Baaj, Roger Härtl, Jeffrey P. Greenfield

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Purpose: Occipitocervical instrumentation is infrequently required for stabilization of the axial and subaxial cervical spine in very young children. However, when it is necessary, unique surgical considerations arise in children when compared with similar procedures in adults. Methods: The authors reviewed literature describing fusion of the occipitocervical junction (OCJ) in toddlers and share their experience with eight cases of young children (age less than or equal to 4 years) receiving occiput to axial or subaxial spine instrumentation and fixation. Diagnoses and indications included severe or secondary Chiari malformation, skeletal dysplastic syndromes, Klippel-Feil syndrome, Pierre Robin syndrome, Gordon syndrome, hemivertebra and atlantal occipitalization, basilar impression, and iatrogenic causes. Results: All patients underwent occipital bone to cervical spine instrumentation and fixation at different levels. Constructs extended from the occiput to C2 and T1 utilizing various permutations of titanium rods, autologous rib autografts, Mersilene sutures, and combinations of autografts with bone matrix materials. All patients were placed in rigid cervical bracing or halo fixation postoperatively. No postoperative neurological deficits or intraoperative vascular injuries occurred. Conclusion: Instrumented arthrodesis can be a treatment option in very young children to address the non-traumatic craniocervical instability while reducing the need for prolonged external halo vest immobilization. Factors affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making that may be unique to the toddler population.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalChild's Nervous System
DOIs
StateAccepted/In press - Jun 29 2018
Externally publishedYes

Fingerprint

Arthrodesis
Spine
Autografts
Platybasia
Klippel-Feil Syndrome
Pierre Robin Syndrome
Occipital Bone
Bone Matrix
Vascular System Injuries
Ribs
Titanium
Immobilization
Sutures
Decision Making
Population
Therapeutics

Keywords

  • Cervical spine
  • Instrumentation
  • Occipital bone
  • Occipitocervical fusion
  • Occipitocervical instability

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Janjua, M. B., Hwang, S. W., Samdani, A. F., Pahys, J. M., Baaj, M-A. ., Härtl, R., & Greenfield, J. P. (Accepted/In press). Instrumented arthrodesis for non-traumatic craniocervical instability in very young children. Child's Nervous System, 1-10. https://doi.org/10.1007/s00381-018-3876-9

Instrumented arthrodesis for non-traumatic craniocervical instability in very young children. / Janjua, M. B.; Hwang, Steven W.; Samdani, Amer F.; Pahys, Joshua M.; Baaj, Mhd-Ali -; Härtl, Roger; Greenfield, Jeffrey P.

In: Child's Nervous System, 29.06.2018, p. 1-10.

Research output: Contribution to journalArticle

Janjua, M. B. ; Hwang, Steven W. ; Samdani, Amer F. ; Pahys, Joshua M. ; Baaj, Mhd-Ali - ; Härtl, Roger ; Greenfield, Jeffrey P. / Instrumented arthrodesis for non-traumatic craniocervical instability in very young children. In: Child's Nervous System. 2018 ; pp. 1-10.
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AB - Purpose: Occipitocervical instrumentation is infrequently required for stabilization of the axial and subaxial cervical spine in very young children. However, when it is necessary, unique surgical considerations arise in children when compared with similar procedures in adults. Methods: The authors reviewed literature describing fusion of the occipitocervical junction (OCJ) in toddlers and share their experience with eight cases of young children (age less than or equal to 4 years) receiving occiput to axial or subaxial spine instrumentation and fixation. Diagnoses and indications included severe or secondary Chiari malformation, skeletal dysplastic syndromes, Klippel-Feil syndrome, Pierre Robin syndrome, Gordon syndrome, hemivertebra and atlantal occipitalization, basilar impression, and iatrogenic causes. Results: All patients underwent occipital bone to cervical spine instrumentation and fixation at different levels. Constructs extended from the occiput to C2 and T1 utilizing various permutations of titanium rods, autologous rib autografts, Mersilene sutures, and combinations of autografts with bone matrix materials. All patients were placed in rigid cervical bracing or halo fixation postoperatively. No postoperative neurological deficits or intraoperative vascular injuries occurred. Conclusion: Instrumented arthrodesis can be a treatment option in very young children to address the non-traumatic craniocervical instability while reducing the need for prolonged external halo vest immobilization. Factors affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making that may be unique to the toddler population.

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