Two-Stage Approach for Unstable Pediatric Craniocervical Junction Anomalies with a Halo Vest and Delayed Occipitocervical Fusion: Technical Note, Case Series, and Literature Review
| Autor: | Julio Valencia-Anguita, Javier Márquez-Rivas, Gloria Moreno-Madueño, Jorge Tirado-Caballero, María José Mayorga-Buiza, Mónica Rivero-Garvía |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Joint Instability
Male medicine.medical_specialty Adolescent External Fixators C1-C2 instability Arthrodesis medicine.medical_treatment Basilar invagination Craniofacial Abnormalities 03 medical and health sciences 0302 clinical medicine Postoperative Complications Platybasia Traction Odontoid Process medicine Goel Humans Stage (cooking) Child Occipitocervical fusion Cervical kyphosis Neck Pain Halo vest Clinical pathology Cerebrospinal fluid leak business.industry medicine.disease Craniocervical junction Os odontoideum Surgery Atlanto-Occipital Joint Treatment Outcome Atlanto-Axial Joint 030220 oncology & carcinogenesis Child Preschool Occipital Bone Ambulatory Female Neurology (clinical) business 030217 neurology & neurosurgery |
| Zdroj: | Digital.CSIC. Repositorio Institucional del CSIC instname |
| Popis: | [Objective] Malformations in the craniocervical junction (CCJ) are rare in the pediatric population but often need surgical treatment. We present a pediatric case series of patients treated with a 2-stage surgical approach with a halo vest and occipitocervical fusion and review complications and outcomes. [Methods] A retrospective analysis of a single-center case series was performed. Pediatric patients affected by congenital craniocervical junction anomalies and treated with a 2-stage approach were included. A halo vest was implanted in the first surgery, and ambulatory progressive reduction was performed. When a favorable anatomic situation was observed, arthrodesis was performed. Safety analysis was undertaken by analyzing the incidence of complications in both procedures. Effectivity analysis was carried out analyzing radiologic and clinical outcome (Goel grade and modified Japanese Orthopaedic Association score). Student t test was used for statistical analysis. [Results] Sixteen cases were included. Mean age of patients was 9.38 years. Safety analysis showed 2 halo loosenings, 1 pin infection, 2 wound infections, 1 cerebrospinal fluid leak, and 2 delayed broken rods. No major complications were observed. Radiologic analysis showed an improvement in the tip of the odontoid process to the McRae line distance (from −3.26 mm to −6.16 mm), atlantodental interval (from 3.05 mm to 1.88 mm), clival-canal angle (from 134.61° to 144.38°), and cervical kyphosis (from 6.39° to 1.54°). Clinical analysis also showed improvement in mean Goel grade (from 1.75 to 1.44) and modified Japanese Orthopaedic Association score (from 15.12 to 16.41). [Conclusions] The 2-stage approach was a suitable and effective treatment for craniocervical junction anomalies in pediatric patients. |
| Databáze: | OpenAIRE |
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