Equivalence of fusion rates after rigid internal fixation of the occiput to C-2 with or without C-1 instrumentation

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  • 1 Department of Neurosurgery, College of Physicians and Surgeons, Columbia University, New York;
  • 2 Department of Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, Washington;
  • 3 Department of Neurosurgery, New York University, New York;
  • 4 Pediatric Neurosurgery Service, Baylor College of Medicine, Clinical Care Center, Houston, Texas;
  • 5 Department of Neurosurgery, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin;
  • 6 Department of Neurological Surgery, University of Florida, Gainesville, Florida;
  • 7 Department of Neurosurgery, Children's Hospital, Boston, Massachusetts;
  • 8 Department of Neurosurgery, All Children's Hospital, St. Petersburg, Florida;
  • 9 Neurosurgeons for Children, P.A., Dallas, Texas;
  • 10 Department of Neurological Surgery, The Children's Hospital at Scott and White, Texas A&M School of Medicine, Temple, Texas; and
  • 11 Division of Pediatric Neurosurgery, Primary Children's Medical Center, Salt Lake City, Utah
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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.

Abbreviations used in this paper: TAS = transarticular screw; VA = vertebral artery.

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Contributor Notes

Address correspondence to: Todd C. Hankinson, M.D., Department of Neurosurgery, Columbia University, College of Physicians and Surgeons, 710 West 168th Street, NI Box #132, New York, New York 10032. email: tch12@columbia.edu.
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