Upper cervical spine fusion in the pediatric population
| Autor: | P D Adelson, David W. Lowry, Brent L. Clyde, Ian F. Pollack, A. L. Albright |
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| Rok vydání: | 1997 |
| Předmět: |
Male
medicine.medical_specialty Adolescent Arthrodesis medicine.medical_treatment Cervical spine fusion Neurological examination Os Odontoideum Traction Medicine Humans Child Subluxation medicine.diagnostic_test business.industry General Medicine medicine.disease Surgery Spinal Fusion Treatment Outcome El Niño Atlanto-Axial Joint Atlantoaxial instability Child Preschool Cervical Vertebrae Spinal Fractures Female Spinal Diseases Neurology (clinical) Radiology Trisomy Complication business Pediatric population |
| Zdroj: | Journal of neurosurgery. 87(5) |
| ISSN: | 0022-3085 |
| Popis: | ✓ The outcomes of 25 pediatric patients who underwent upper cervical or occipitocervical fusion at the authors' institution since 1983 were reviewed. At a mean age of 9 years, the patients presented with spinal instability that was associated with os odontoideum in 11 cases, rotatory subluxation in five cases, odontoid fracture in two cases, atlantooccipital dislocation in two cases, and congenital atlantoaxial instability in five patients, four of whom had Down's syndrome (trisomy 21). Ten children had abnormal findings on neurological examination preoperatively; however, nine experienced improvement or resolution of deficits as of their latest follow-up evaluation (mean 17 months). Fusion was achieved with the first operation in 21 of 25 patients; eventually it was attained in all but one. Four patients exhibited persistent spinal instability after an initial procedure. This was caused by erosion of a multistranded cable through the intact arch of C-2 in two cases, by pin site infection necessitating early halo removal in one case, and by slippage in a halo following a Gallie procedure, which was revised with a Brooks fusion in one case. This series, the largest yet published, shows that with appropriate surgical management, posterior upper cervical fusion in the pediatric population is highly successful. Careful attention to halo pin site care and caution in using multistranded cable in young patients may improve results. |
| Databáze: | OpenAIRE |
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