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Craniovertebral junction fixation in children less than 5 years

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Abstract

Purpose

Whilst rigid fixation for craniovertebral instability is the gold standard, in very young, small children conventional management may have to be modified. We present a single-centre experience of craniocervical fixation in children under 5 years.

Methods

A retrospective review of cases that had undergone atlantoaxial (AA) or occipitocervical (OC) fixation aged under 5 years. Fusion was assessed using computerised tomography or flexion extension X-rays.

Results

Twenty-six children (median age 2.3, range 0.8–4.9 years, 19 under the age of 3) underwent OC (n = 19) or AA (n = 7) fusion between 1999 and 2016. Pathology comprised 17 congenital, five trauma, two tumour and two post-infection cases. Twenty-one patients underwent sublaminar cable fixation with calvarial, autologous bone graft and halo-body orthosis immobilisation. An occipital plate and rods to sublaminar wire construct were used in four cases. A rigid instrumented fixation with occipital plate and C2 pedicle screws was utilised in one case. Follow-up was for a median of 2.8 years (range 0.03–16.3 years). Initial fusion rate was 91%, reaching 100% following two re-operations. Ninety-two per cent of patients were neurologically stable or improved following surgery. Twenty-one patients had a good overall outcome. Two patients had post-operative neurological deteriorations, and four died due to non-procedure related causes. Pin site morbidity secondary to halo use occurred in five cases.

Conclusion

High fusion rates with good outcomes are achievable using semi-rigid fixation in the under 5-year-olds. Full thickness, autologous calvarial bone graft secured with wire cables and halo external orthosis offers a safe and effective alternative technique when traditional screw instrumentation is not feasible.

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Acknowledgements

PG and DT were employed by Great Ormond Street Hospital, London, UK.

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  1. Department of Neurosurgery, Great Ormond Street Hospital, 34 Great Ormond Street, London, WC1N 3JH, UK

    Patrick J. Grover, Lauren S. Harris & Dominic N. P. Thompson

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  1. Patrick J. Grover
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Grover, P.J., Harris, L.S. & Thompson, D.N.P. Craniovertebral junction fixation in children less than 5 years. Eur Spine J 29, 961–969 (2020). https://doi.org/10.1007/s00586-020-06313-x

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