The Outcomes of Posterior Arthrodesis for Atlantoaxial Subluxation in Down Syndrome Patients: A Meta-Analysis.

Autor:	Scollan JP; Downstate College of Medicine, State University of New York, Brooklyn, NY., Alhammoud A; Hamad Medical Corporation, Doha, Qatar., Tretiakov M; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Hollern DA; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Bloom LR; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Shah NV; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Naziri Q; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Diebo BG; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Yoshihara H; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Scott CB; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Hesham K; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY., Paulino CB; Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, Brooklyn, NY.
Jazyk:	angličtina
Zdroj:	Clinical spine surgery [Clin Spine Surg] 2018 Aug; Vol. 31 (7), pp. 300-305.
DOI:	10.1097/BSD.0000000000000658
Abstrakt:	Study Design: This is a meta-analysis. Objective: To establish rates of (1) neurological complications, (2) bony-related complications, (3) complications delaying recovery, (4) reoperation, and (5) fatalities following posterior cervical arthrodesis in Down syndrome (DS) patients with atlantoaxial subluxation. To determine if presenting symptoms had any relationship to postoperative complications. Summary of Background Data: Posterior arthrodesis is commonly utilized to correct cervical instability secondary to atlantoaxial instability in DS patients. However, there has never been a global evaluation of postoperative complications associated with posterior cervical spinal arthrodesis in DS patients. Methods: A comprehensive search of Medline/PubMed, EMBASE, and Ovid databases between January 1980 and July 2017 was utilized to identify DS patients with atlantoaxial subluxation who underwent posterior cervical arthrodesis. Data were sorted by neurological complications, complications delaying recovery, bony-related complications, reoperations, and fatalities. Patients were sorted into 2 groups based on presentation with or without neurological deficits. Results: Twelve studies met inclusion criteria, including 128 DS patients. Mean age was 13.8 years (range: 6.7-32.7 y; 47.8% male). Mean follow-up was 31.7 months (range: 14.9-77 mo). All patients underwent primary posterior cervical arthrodesis with an average of 2.5 vertebrae fused. A total of 39.6% of patients had bony-related complications [95% confidence interval (CI), 31.4%-48.5%], 23.3% had neurological deficits (95% CI, 16.6%-31.6%), and 26.4% experienced complications delaying recovery (95% CI, 19.4%-34.9%). The reoperation rate was 34.9% (95% CI, 25.5%-45.6%). The mortality rate was 3.9% (95% CI, 1.5%-9.7%). Neurological complications were 4-fold (P<0.05) and reoperation was 5.5-fold (P<0.05) more likely in patients presenting with neurological deficits compared with those without. Conclusions: This study detailed global complication rates of posterior arthrodesis for DS patients, identifying bony-related complications and reoperations among the most common. Patients presenting with neurological symptoms and cervical instability have increased postoperative rates of neurological complications and reoperations than patients with instability alone. Further investigation into how postoperative complications effect patient independence is warranted.
Databáze:	MEDLINE
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