Instrumented arthrodesis for non-traumatic craniocervical instability in very younger kids.
Childs Nerv Syst. 2018 Jun 29;:
Authors: Janjua MB, Hwang SW, Samdani AF, Pahys JM, Baaj AA, Härtl R, Greenfield JP
PURPOSE: Occipitocervical instrumentation is sometimes required for stabilization of the axial and subaxial cervical backbone in very younger kids. Nevertheless, when it’s obligatory, distinctive surgical concerns come up in kids in comparison with related procedures in adults.
METHODS: The authors reviewed literature describing fusion of the occipitocervical junction (OCJ) in toddlers and share their expertise with eight instances of younger kids (age lower than or equal to four years) receiving occiput to axial or subaxial backbone instrumentation and fixation. Diagnoses and indications included extreme 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 sufferers underwent occipital bone to cervical backbone instrumentation and fixation at totally different ranges. Constructs prolonged from the occiput to C2 and T1 using numerous permutations of titanium rods, autologous rib autografts, Mersilene sutures, and combos of autografts with bone matrix supplies. All sufferers had been positioned in inflexible cervical bracing or halo fixation postoperatively. No postoperative neurological deficits or intraoperative vascular accidents occurred.
CONCLUSION: Instrumented arthrodesis is usually a therapy possibility in very younger kids to handle the non-traumatic craniocervical instability whereas decreasing the necessity for extended exterior halo vest immobilization. Components affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making that could be distinctive to the toddler inhabitants.
PMID: 29959504 [PubMed – as supplied by publisher]