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Richard C. E. Anderson, Peter Kan, Wayne M. Gluf and Douglas L. Brockmeyer

Object

Despite decades of surgical experience, the long-term consequences of occipitocervical (OC) and atlantoax-ial (C1–2) fusions in children are unknown. The purpose of this study was to determine the long-term effects of these fusions on growth and alignment of the maturing cervical spine.

Methods

A retrospective chart review was conducted for patients 6 years of age or younger (mean 4.7 years, range 1.7–6.8 years) who underwent OC or C1–2 fusion at the Primary Children’s Medical Center at the University of Utah within the last 10 years. Immediate postoperative plain radiographs and computed tomography (CT) scans were compared with the most recent plain and dynamic radiographs to assess changes in spinal growth and alignment.

Seventeen children met entry criteria for the study. All patients had fusion documented on follow-up radiography or CT scans. At a mean follow up of 28 months, there were no cases of sagittal malalignment (kyphotic or swanneck deformity), subaxial instability (osteophyte formation or subluxation), or unintended fusion of adjacent levels. The lordotic curvature of the cervical spine increased from a mean of 15° postoperatively to 27° at follow up (p = 0.06). A mean of 34% of the vertical growth of the cervical spine occurred within the fusion segment. When data were analyzed pertaining to a subgroup of five patients who underwent follow-up periods for longer than 48 months (mean 50.2 months, range 48–54 months), similar results were seen.

Conclusions

Preliminary follow-up results indicate that, compared with older children, children 6 years of age or younger undergoing OC or C1–2 fusion are not at an increased risk of spinal deformity or subaxial instability. Longer follow-up periods, during which measurements of the spinal canal are taken, will be necessary to determine precisely how children’s spines grow and remodel after an upper cervical spine fusion.

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Richard C. E. Anderson, Brian T. Ragel, J Mocco, Leif-Erik Bohman and Douglas L. Brockmeyer

; pars = pars screw; TAS = transarticular screw; TL = translaminar screw; TSRH = Texas Scottish Rite Hospital; –– = no screw. Illustrative Cases Case 3 Unilateral C1–2 Transarticular Screw With Contralateral Harms Construct This 13-year-old boy presented with transient quadriparesis after sustaining an injury while boxing ( Table 1 ). Results of his neurological examination returned to normal after 24 hours of treatment with steroids. Plain and dynamic x-ray films demonstrated an os odontoideum with 8 mm of subluxation at C1–2. A thin-cut CT scan with

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Atul Goel

fixation for atlantoaxial subluxation . Acta Neurochir (Wien) 129 : 47 – 53 , 1994 12 Goel A , Muzumdar D , Dange N : One stage reduction and fixation for atlantoaxial spondyloptosis: report of four cases . Br J Neurosurg 20 : 209 – 213 , 2006 13 Goel A , Muzumdar D , Dange N : Syringomyelia in infants secondary to mobile congenital atlantoaxial dislocation . Pediatr Neurosurg 43 : 15 – 18 , 2007 14 Goel A , Muzumdar D , Dindorkar K , Desai K : Atlantoaxial dislocation associated with stenosis of the canal at atlas . J

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Zachary L. Hickman, Michael M. McDowell, Sunjay M. Barton, Eric S. Sussman, Eli Grunstein and Richard C. E. Anderson

reduction of the C1–2 subluxation was obtainable. The patient was extubated the following day and began oral intake the day after. Postoperative CT imaging confirmed resolution of the cervicomedullary compression. The patient improved neurologically and had substantial motor strength gains in all extremities. By the time of discharge, he was ambulating with assistance and was able to accomplish functional tasks such as dressing and feeding himself. A formal evaluation demonstrated minimal swallowing impairment, and although the patient was functionally capable of normal

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Benjamin C. Kennedy, Randy S. D’Amico, Brett E. Youngerman, Michael M. McDowell, Kristopher G. Hooten, Daniel Couture, Andrew Jea, Jeffrey Leonard, Sean M. Lew, David W. Pincus, Luis Rodriguez, Gerald F. Tuite, Michael L. Diluna, Douglas L. Brockmeyer, Richard C. E. Anderson and Pediatric Craniocervical Society

B oth occipitocervical (OC) and atlantoaxial (AA) instability are common problems encountered by pediatric spine surgeons. There are a wide variety of possible etiologies for pediatric OC and AA instability, including trauma, Down syndrome, os odontoideum, infection, mucopolysaccharidosis, atlantoaxial rotatory subluxation, juvenile rheumatoid arthritis, tumors, spondyloepiphyseal dysplasia, iatrogenic causes, and others. 4 , 13 , 20 , 30 , 32 , 40 It has been shown that trauma is the most common cause of OC and AA instability, with younger children being

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Kyle T. Johnson, Wajd N. Al-Holou, Richard C. E. Anderson, Thomas J. Wilson, Tejas Karnati, Mohannad Ibrahim, Hugh J. L. Garton and Cormac O. Maher

not within the spine. Two hundred thirty-nine patients initially selected by randomization were subsequently excluded from this study, 131 of them (54.8%) due to a condition affecting the cervical spine. Of the 34 different conditions noted, the most common were scoliosis, congenital cervical fusion, and torticollis. Other exclusions were as follows: 14 patients (5.8%) with a finding of acute cervical spine fracture; 6 patients (2.5%) with acute cervical subluxation; 9 patients (3.8%) with a previous cervical fracture or subluxation; 34 patients (14.2%) with poor

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Jayapalli Rajiv Bapuraj, Amy K. Bruzek, Jamaal K. Tarpeh, Lindsey Pelissier, Hugh J. L. Garton, Richard C. E. Anderson, Bin Nan, Tianwen Ma and Cormac O. Maher

patients (5.9%) with a finding of an acute cervical spine fracture; 6 patients (2.5%) with an acute cervical subluxation; 9 patients (3.8%) with a history of cervical fracture or subluxation; 34 patients (14.2%) with poor sagittal alignment on CT scanning, precluding accurate measurements; 18 patients (7.5%) with significant motion artifact on the scan that limited our ability to make accurate measurements; 13 patients (5.4%) whose cervical spine CT scan did not include the entire cervical spine from the basion to C7; and 14 patients (5.9%) who lacked a complete set of

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Jonathan E. Martin, Brandon G. Rocque, Andrew Jea, Richard C. E. Anderson, Joshua Pahys and Douglas Brockmeyer

. Pediatrics 80 : 555 – 560 , 1987 18 Selby KA , Newton RW , Gupta S , Hunt L : Clinical predictors and radiological reliability in atlantoaxial subluxation in Down’s syndrome . Arch Dis Child 66 : 876 – 878 , 1991 19 Taggard DA , Menezes AH , Ryken TC : Instability of the craniovertebral junction and treatment outcomes in patients with Down’s syndrome . Neurosurg Focus 6 ( 6 ): e3 , 1999 20 Tishler J , Martel W : Dislocation of the atlas in mongolism: preliminary report . Radiology 84 : 904 – 906 , 1965 21 Uno K , Kataoka O