Document Detail


Equivalence of fusion rates after rigid internal fixation of the occiput to C-2 with or without C-1 instrumentation.
MedLine Citation:
PMID:  20367344     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECT: The object of this study was to assess a multiinstitutional experience with pediatric occipitocervical constructs to determine whether a difference exists between the fusion and complication rates of constructs with or without direct C-1 instrumentation. METHODS: Seventy-seven cases of occiput-C2 instrumentation and fusion, performed at 9 children's hospitals, were retrospectively analyzed. Entry criteria included atlantooccipital instability with or without atlantoaxial instability. Any case involving subaxial instability was excluded. Constructs were divided into 3 groups based on the characteristics of the anchoring spinal instrumentation: Group 1, C-2 instrumentation; Group 2, C-1 and C-2 instrumentation without transarticular screw (TAS) placement; and Group 3, any TAS placement. Groups were compared based on rates of fusion and perioperative complications. RESULTS: Group 1 consisted of 16 patients (20.8%) and had a 100% rate of radiographically demonstrated fusion. Group 2 included 22 patients (28.6%), and a 100% fusion rate was achieved, although 2 cases were lost to follow-up before documented fusion. Group 3 included 39 patients (50.6%) and demonstrated a 100% radiographic fusion rate. Complication rates were 12.5, 13.7, and 5.1%, respectively. There were 3 vertebral artery injuries, 1 (4.5%) in Group 2 and 2 (5.1%) in Group 3. CONCLUSIONS: High fusion rates and low complication rates were achieved with each configuration examined. There was no difference in fusion rates between the group without (Group 1) and those with (Groups 2 and 3) C-1 instrumentation. These findings indicated that in the pediatric population, excellent occipitocervical fusion rates can be accomplished without directly instrumenting C-1.
Authors:
Todd C Hankinson; Anthony M Avellino; David Harter; Andrew Jea; Sean Lew; David Pincus; Mark R Proctor; Luis Rodriguez; David Sacco; Theodore Spinks; Douglas L Brockmeyer; Richard C E Anderson
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of neurosurgery. Pediatrics     Volume:  5     ISSN:  1933-0715     ISO Abbreviation:  J Neurosurg Pediatr     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-04-06     Completed Date:  2010-04-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101463759     Medline TA:  J Neurosurg Pediatr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  380-4     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA. tch12@columbia.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Atlanto-Axial Joint / radiography,  surgery
Axis / radiography,  surgery*
Cervical Atlas / radiography,  surgery*
Child
Child, Preschool
Follow-Up Studies
Humans
Infant
Internal Fixators*
Joint Instability / radiography,  surgery*
Occipital Bone / radiography,  surgery*
Retrospective Studies
Spinal Fusion / instrumentation*,  methods*
Tomography, X-Ray Computed

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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