Abstract
Study Design
Retrospective case series.
Objectives
To describe the indications and outcomes of cervical fixation using modern instrumentation in a case series of pediatric Down syndrome (DS) patients.
Summary of Background Data
Cervical instability is the major cervical spine concern in children with DS. Although fixation techniques have advanced over the past quarter-century, the outcome of fixation with modern instrumentation for upper cervical instability in DS patients has not been thoroughly investigated.
Methods
We searched the orthopedic database at our institution for patients with a diagnosis of DS who had undergone a cervical spine fusion between 2006 and 2017. Patient demographics, diagnoses, surgical indications, surgical details, and complications were recorded. Preoperative imaging was reviewed to determine atlanto-dens intervals and spinal cord signal changes. Postoperative radiographs or CT scans were reviewed to determine union.
Results
Twelve DS patients met our inclusion criteria. The mean age at surgery was 9.3 years (range 3.8–18.8 years). Patients with secondary causes of instability included 7 patients with os odontoideum and 1 patient with a pars fracture. Three patients (25%) were identified on asymptomatic screening, with none of these having cord signal changes on magnetic resonance imaging (MRI). Modern implants (screws, plates, cages) were used in every patient in our series. The mean number of levels fused was 1.9 (range 1–5). The overall complication rate was 41.7% (5/12). Four patients required repeat surgery for nonunion. All patients with adequate radiographic follow-up demonstrated union (11/11, 100%). One patient was lost to follow-up.
Conclusions
Fixation for cervical instability is a critical component of the management of DS. A minority of patients receiving surgery were identified through asymptomatic screening. There was a high complication risk associated with surgery in our study; however, the addition of rigid fixation has lessened the complication rate compared with previous studies.
Level of Evidence
Level IV.
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Author disclosures: BWY (none), DJH (none), MRP (none), MT (none), MTH (other from Medtronics, outside the submitted work), MPG (other from Orthobullets, NuVasive, DePuy, Zimmer Biomet, Medtronic, Growing Spinal Study Group [GSSG], Children’s Spine Study Group [CSSG], and Harms Study Group [HSG], outside the submitted work).
IRB approval: This research was approved by our institutional IRB (IRB Number: P00020884).
Funding: No funding sources to disclose.
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Yang, B.W., Hedequist, D.J., Proctor, M.R. et al. Surgical Fixation Using Screw-Rod Construct Instrumentation for Upper Cervical Instability in Pediatric Down Syndrome Patients. Spine Deform 7, 957–961 (2019). https://doi.org/10.1016/j.jspd.2019.03.002
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DOI: https://doi.org/10.1016/j.jspd.2019.03.002