Surgery for Upper Cervical Spine Instabilities in Children |
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Authors: | B Meyer U Vieweg J G Rao M Stoffel J Schramm |
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Institution: | (1) Department of Neurosurgery, University of Bonn, Germany, DE |
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Abstract: | Summary.
Summary.
Background: Due to the paucity of existing data with regard to surgical fusion of upper cervical spine instabilities in the paediatric
population, we feel encouraged to report the results of our own series to provide additional information to the available
body of literature.
Methods: Since 1991 N=11 children underwent a total of N=13 surgical procedures for N=8 posttraumatic, N=2 congenital and N=1 postinfectious
instabilities at a mean age of 10 years (range: 3–16 years). Transoral odontectomies, ventral odontoid screw-fixations, dorsal
wiring or -clamping and transarticular screw-fixations were performed for stabilization and iliac crest bone graft used for
fusion. Pain scores, neurological status and radiological results were documented at regular intervals (mean follow-up: 25.4
months).
Results: Stable fusion was achieved in all patients as documented on flexion/extension films and tomographies. At the latest follow-up
N=2 patients had improved and N=9 were equal to their preoperative neurological status. Pain scores were improved in N=9 patients.
N=2 children developed “bystander-fusion” after C0/2 wiring. N=3 peri-operative complications occurred as transient neurological
deteriorations. In one case this resulted from the resection of a lower brainstem tumour prior to the stabilization procedure.
One was attributed to sublaminar wiring in the case of an os odontoideum and one occurred due to slippage of the halo orthosis
after transoral odontectomy before definitive dorsal stabilization was carried out.
Interpretation: In accordance with the recent literature, we argue for the application of modern screw fixations and treatment algorithms
as established for adults in upper cervical spine instabilities of older children. Techniques and indications remain problematic
for those younger than 6 years and may have to be individualized in congenital instabilities. |
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Keywords: | : Upper cervical spine instability children fusion techniques |
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