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occipital cervical fusion children

Brian J Kelley, Anas A Minkara, Peter D Angevine, Michael G Vitale, Lawrence G Lenke, Richard C E Anderson
OBJECTIVE The long-term effects of instrumentation and fusion of the occipital-cervical-thoracic spine on spinal growth in young children are poorly understood. To mitigate the effects of this surgery on the growing pediatric spine, the authors report a novel technique used in 4 children with severe cervical-thoracic instability. These patients underwent instrumentation from the occiput to the upper thoracic region for stabilization, but without bone graft at the craniovertebral junction (CVJ). Subsequent surgery was then performed to remove the occipital instrumentation, thereby allowing further growth and increased motion across the CVJ...
October 2017: Neurosurgical Focus
Hiroki Oba, Jun Takahashi, Kyoko Takano, Yuji Inaba, Mitsuo Motobayashi, Gen Nishimura, Shugo Kuraishi, Masayuki Shimizu, Shota Ikegami, Toshimasa Futatsugi, Masashi Uehara, Tomoki Kosho, Hiroyuki Kato, Koki Uno
STUDY DESIGN: Case report. OBJECTIVE: We report here on an 18-month-old boy with brachytelephalangic chondrodysplasia punctata (BCDP), whose atlantoaxial instability was successfully managed with occipitocervical instrumented fusion (OCF) using screw and rod instrumentations. SUMMARY OF BACKGROUND DATA: Recently, there have been a number of reports on BCDP with early onset of cervical myelopathy. Surgical OCF is a vital intervention to salvage affected individuals from the life-threatening morbidity...
December 1, 2017: Spine
Vijay M Ravindra, Jay Riva-Cambrin, Kevin P Horn, Jason Ginos, Russell Brockmeyer, Jian Guan, John Rampton, Douglas L Brockmeyer
OBJECTIVE Measurement of the occipital condyle-C1 interval (CCI) is important in the evaluation of atlantooccipital dislocation (AOD) in pediatric trauma patients. The authors studied a large cohort of children with and without AOD to identify a 2D measurement threshold that maximizes the diagnostic yield of the CCI on cervical spine CT scans obtained in trauma patients. METHODS This retrospective, single-center study included all children who underwent CT of the cervical spine at Primary Children's Hospital from January 1, 2011, through December 31, 2014, for trauma evaluation...
April 2017: Journal of Neurosurgery. Pediatrics
A Y Mushkin, A V Gubin, E V Ulrich, V P Snischuk
PURPOSE: To describe the clinical and radiological characteristics of uncommon upper cervical spine abnormality in children. METHODS: Clinical and diagnostic characteristics of three patients aged 6-12 years with a similar uncommon type of occipital anomaly are described. The patients were admitted in 2007, 2009, and 2014, respectively. RESULTS: All patients were clinically and radiologically examined. In each case the massive, additional unilateral outgrowth of the occipital bone (os occipitale) was visualized...
May 2016: European Spine Journal
Nicolene Lottering, Donna M MacGregor, Clair L Alston, Debbie Watson, Laura S Gregory
Contemporary, population-specific ossification timings of the cranium are lacking in current literature due to challenges in obtaining large repositories of documented subadult material, forcing Australian practitioners to rely on North American, arguably antiquated reference standards for age estimation. This study assessed the temporal pattern of ossification of the cranium and provides recalibrated probabilistic information for age estimation of modern Australian children. Fusion status of the occipital and frontal bones, atlas, and axis was scored using a modified two- to four-tier system from cranial/cervical DICOM datasets of 585 children aged birth to 10 years...
January 2016: Journal of Forensic Sciences
Rakesh Gupta, Sharadendu Narayan
BACKGROUND: The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury. METHODS: In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done...
November 2015: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
H J Lee, J T Kim, M H Shin, D Y Choi, Y S Park, J T Hong
AIM: To retrospectively analyse the synchondrosis from the occipital bone to the whole cervical spine and determine the feasibility and validity of age estimation using computed tomography (CT) images. MATERIAL AND METHODS: A total of 231 cervical spine or neck CT images of young children (<7 years of age) were examined. Twelve ossification centres were assessed (occiput: n = 2; atlas: n = 2; axis, n = 6; whole sub-axial vertebra: n = 2), and the ossification process was graded as open (O, fully lucent), osseous bridging (B, partially ossified), and fusion (F, totally ossified)...
August 2015: Clinical Radiology
Ilkka Helenius, Haemish Crawford, Paul D Sponseller, Thierry Odent, Robert M Bernstein, Anthony A Stans, Daniel Hedequist, Jonathan H Phillips
BACKGROUND: Upper cervical instability is common in many skeletal dysplasias, and surgical treatment can be difficult because of small, fragile osseous elements. In this study of children with skeletal dysplasia and upper cervical instability, we compared fusion rates and complications between (1) patients treated with no instrumentation or with wiring techniques and (2) those who underwent rigid cervical spine instrumentation. We also sought to characterize the presentation and common parameters of upper cervical instability in this population...
February 4, 2015: Journal of Bone and Joint Surgery. American Volume
Thierry Odent, Rony Bou Ghosn, Jean-Paul Dusabe, Michel Zerah, Christophe Glorion
PURPOSE: Evaluation of effectiveness of internal rigid fixation for occipito-cervical fusion with occipital hooks and cervical screws and/or hooks to improve fusion in young or small children with various bone dysplasia or congenital abnormality. METHODS: Fourteen children with mean age of 8.4 years and height and weight below 140 cm and 35 kg, respectively, who underwent occipito-cervical fusion for miscellaneous pathologies reading to stenosis and/or instability were reviewed...
January 2015: European Spine Journal
Jennifer G Savage, Daniel H Fulkerson, Anish N Sen, Jonathan G Thomas, Andrew Jea
UNLABELLED: OBJECT.: There are rare indications for upper cervical spine fusion in young children. Compared with nonrigid constructs, rigid instrumentation with screw fixation increases the fusion rate and reduces the need for halo fixation. Instrumentation may be technically challenging in younger children. A number of screw placement techniques have been described. Use of C-2 translaminar screws has been shown to be anatomically feasible, even in the youngest of children. However, there are few data detailing the clinical outcome...
July 2014: Journal of Neurosurgery. Pediatrics
Arnold H Menezes, Raheel Ahmed
OBJECT: Atlantoaxial tumors account for a substantial proportion of primary bone tumors in children. Before resection, surgeons must consider the complex regional anatomy, the potential for neurological compromise, craniocervical instability, and the question of tumor resectability in a growing spine. Using current technology, the authors analyzed surgical cases in this light and present outcomes and treatment recommendations after long-term patient follow-up. METHODS: The authors reviewed clinical records for 23 children whose primary atlantoaxial bone tumors were treated from 1996 through 2010...
March 2014: Journal of Neurosurgery. Pediatrics
Libby Kosnik-Infinger, Steven S Glazier, Bruce M Frankel
Fixation at the craniovertebral junction (CVJ) is necessary in a variety of pediatric clinical scenarios. Traditionally an occipital bone to cervical fusion is preformed, which requires a large amount of hardware to be placed on the occiput of a child. If a patient has previously undergone a posterior fossa decompression or requires a decompression at the time of the fusion procedure, it can be difficult to anchor a plate to the occipital bone. The authors propose a technique that can be used when faced with this difficult challenge by using the occipital condyle as a point of fixation for the construct...
January 2014: Journal of Neurosurgery. Pediatrics
Jeffrey Knox, John Schneider, Robert L Wimberly, Anthony I Riccio
BACKGROUND: Nonaccidental trauma (NAT) is considered an uncommon cause of spine trauma in the pediatric population. Little has been published on such injuries and no large series is available in the literature. The purpose of this study is to describe the incidence and characteristics of spine trauma secondary to NAT. METHODS: An IRB-approved retrospective review of all patients presenting to a single level 1 pediatric trauma center with a spinal injury between 2003 and 2011 was performed...
June 2014: Journal of Pediatric Orthopedics
Ji Min Ling, Rajendra Tiruchelvarayan, Wan T Seow, Hua Bi Ng
BACKGROUND: Surgical treatment of C1/C2 subluxation has evolved significantly over the past 2 decades, from the relatively simpler posterior wiring to more technically demanding instrumentations such as C1 lateral mass screws - C2 pedicle screws, C1/C2 transarticular screws, and occipital cervical fusion. Navigation with fluoroscopy is currently the standard of practice in most centers. However, fluoroscopy at this level carries several major drawbacks, such as blockage by the mandible and inability to produce axial images for assessment of the reduction of rotatory subluxation...
2013: Surgical Neurology International
Paul Klimo, Nelson Astur, Kyle Gabrick, William C Warner, Michael S Muhlbauer
OBJECT: Many methods to stabilize and fuse the craniocervical junction have been described. One of the early designs was a contoured (Luque) rod fixated with wires, the so-called Hartshill-Ransford loop. In this study, the authors report their 20-year experience with this surgical technique in children. METHODS: The authors reviewed the medical records of patients 18 years of age or younger who underwent dorsal occipitocervical fusion procedures between March 1992 and March 2012 at Le Bonheur Children's Hospital using a contoured rod and wire construct...
February 2013: Journal of Neurosurgery. Pediatrics
Eric Anthony Sribnick, Vladamir Y Dadashev, Barunashish Brahma, David M Wrubel
OBJECT: The authors describe the use of inside-outside occipital screws in 21 children with occipitocervical instability requiring occipitocervical fusion. METHODS: The ages of the patients were from 2 to 15 years, and patients presented with a variety of causes of occipitocervical instability, including congenital disorders, posttraumatic instability, idiopathic degeneration, and postoperative instability. Surgeries frequently included foramen magnum decompression, duraplasty, and laminectomy, but all patients required occipitocervical instrumentation and arthrodesis...
November 2012: Journal of Neurosurgery. Pediatrics
Robert J Bollo, Jay Riva-Cambrin, Meghan M Brockmeyer, Douglas L Brockmeyer
OBJECT: Chiari malformation Type I (CM-I) is a congenital anomaly often treated by decompressive surgery. Patients who fail to respond to standard surgical management often have complex anomalies of the craniovertebral junction and brainstem compression, requiring reduction and occipitocervical fusion. The authors hypothesized that a subgroup of "complex" patients defined by specific radiographic risk factors may have a higher rate of requiring occipitocervical fusion. METHODS: A retrospective review was conducted of clinical and radiographic data in pediatric patients undergoing surgery for CM-I between 1995 and 2010...
August 2012: Journal of Neurosurgery. Pediatrics
Saira Haque, Badar Bin Bilal Shafi, Musa Kaleem
The normal anatomy of the cervical spine and various imaging techniques for the evaluation of torticollis are reviewed, and possible causes of torticollis in infants and children are discussed, with an emphasis on relevant imaging findings. Torticollis is a congenital or acquired deformity characterized by rotational deformity of the cervical spine with secondary tilting of the head. Although torticollis is a sign of an underlying disease process, its presence does not imply a specific diagnosis, and the cause should be sought if torticollis persists or is associated with other symptoms...
March 2012: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Edward C Benzel, Donald H Zhang, Christopher Iannotti, Daniel Refai, Paul Ruggieri, Ajit Krishnaney
BACKGROUND: For children who survive traumatic atlantooccipital dislocation (AOD), early surgical stabilization and arthrodesis of the occipitoatlantoaxial complex is typically performed. Because of the unique and crowded anatomy of the occipitocervical junction, the creation of a fusion construct that is both safe and biomechanically sound is extremely challenging, especially in infants. We present a technical report of a patient with infantile type I AOD with gross instability, who underwent surgical stabilization consisting of occiput to C2 arthrodesis using autologous rib, augmented with bone morphogenic protein 2 (BMP-2), Mersilene suture, and Ethibond suture as "cross-connectors...
December 2012: World Neurosurgery
Ryoji Tauchi, Shiro Imagama, Zenya Ito, Kei Ando, Kenichi Hirano, Akio Muramoto, Hiroki Matsui, Fumihiko Kato, Yasutsugu Yukawa, Koji Sato, Tokumi Kanemura, Hisatake Yoshihara, Mitsuhiro Kamiya, Yukihiro Matsuyama, Naoki Ishiguro
INTRODUCTION: Atlantoaxial instability (AAI) is an uncommon disease in children. Surgical treatment of pediatric patients with AAI poses a challenge to spine surgeons because of the patients' immature bone quality, extensive anatomical variability, and smaller osseous structures. In this study, the authors report complications and outcomes after posterior fusion in children with AAI. METHODS: The authors reviewed medical records of patients 13 years old and younger with AAI who underwent posterior fusion in the Nagoya Spine Group hospitals, a multicenter cooperative study group, from January 1995 to December 2007...
July 2012: European Spine Journal
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