Instrumented arthrodesis for non-traumatic craniocervical instability in very younger youngsters.
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 youngsters. Nevertheless, when it’s obligatory, distinctive surgical issues come up in youngsters 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 youngsters (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 completely different ranges. Constructs prolonged from the occiput to C2 and T1 using varied permutations of titanium rods, autologous rib autografts, Mersilene sutures, and mixtures 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 remedy choice in very younger youngsters to deal with the non-traumatic craniocervical instability whereas lowering the necessity for extended exterior halo vest immobilization. Elements affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making which may be distinctive to the toddler inhabitants.
PMID: 29959504 [PubMed – as supplied by publisher]