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Haddad E, Al Khoury Salem H, Dohin B. Diagnosis and treatment of cervical spine injuries in children. Orthop Traumatol Surg Res 2024; 110:103762. [PMID: 37992867 DOI: 10.1016/j.otsr.2023.103762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/28/2023] [Accepted: 05/11/2023] [Indexed: 11/24/2023]
Abstract
Cervical spine injuries in children are a common reason for emergency room visits, while bone, ligament or spinal cord cervical lesions are relatively rare (1-1.5% of severe trauma in children) and mainly involve the upper cervical spine. The main causes are sports injuries, accidents at home and traffic accidents. Clinical triage is needed to avoid unnecessary radiation exposure from imaging. We propose a protocol to optimize the diagnosis and treatment. In children, conservative treatment using rigid immobilization (cervical collar or halo-vest) is the preferred option in stable and/or minimally displaced injuries. Frequent clinical and radiological monitoring is required to ensure the patient's condition does not deteriorate due to inappropriate or poorly tolerated treatment. In these cases, surgical treatment can be proposed as second-line treatment. Internal fixation is indicated as the first-line treatment if the injury is unstable or a neurological deficit is present. The fixation methods must be adapted to the pediatric population by taking into account the vertebral volume and residual growth potential. Intraoperative CT scans or neuronavigation can make the surgical procedure safer and easier. Clinical, radiographic and CT scan monitoring should continue until the end of growth in a child who underwent surgical treatment to quickly detect any mechanical complications or sagittal imbalance due to poor craniocervical or cervicothoracic alignment. LEVEL OF EVIDENCE: IV.
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Affiliation(s)
- Elie Haddad
- Service de chirurgie pédiatrique du Pr. SCALABRE, centre hospitalo-universitaire de Saint-Étienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - Hassan Al Khoury Salem
- Service de chirurgie pédiatrique du Pr. SCALABRE, centre hospitalo-universitaire de Saint-Étienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
| | - Bruno Dohin
- Service de chirurgie pédiatrique du Pr. SCALABRE, centre hospitalo-universitaire de Saint-Étienne, hôpital Nord, avenue Albert-Raimond, 42270 Saint-Priest-en-Jarez, France.
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Englert EG, Daley E, Metcalf B, Zaltz I, Khalil J, Settecerri JJ. Langerhans Cell Histiocytosis in the Pediatric Spine Requiring Stabilization: A Literature Review and Report of 3 Cases. JBJS Case Connect 2023; 13:01709767-202306000-00055. [PMID: 37319308 DOI: 10.2106/jbjs.cc.22.00450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
CASE This report describes 3 cases of Langerhans cell histiocytosis (LCH) of the cervical and thoracic spine in patients aged 4 to 10 years. Each patient had painful lytic spinal lesions with vertebral body collapse and posterior involvement suggesting instability requiring corpectomy, grafting, and fusion. All 3 patients were doing well at their most recent follow-up without pain or recurrence. CONCLUSION Although LCH of the pediatric spine is usually successfully treated non-operatively, we recommend corpectomy and fusion when there is instability of the spinal column and/or severe stenosis. Posterior element involvement occurred in all 3 cases and may lead to instability.
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Affiliation(s)
| | - Erika Daley
- Riley Children's Health, Indianapolis, Indiana
| | | | - Ira Zaltz
- Beaumont Hospital, Royal Oak, Michigan
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3
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Alexiades NG, Parisi F, Anderson RCE. Pediatric Spine Trauma: A Brief Review. Neurosurgery 2020; 87:E1-E9. [PMID: 32374883 DOI: 10.1093/neuros/nyaa119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Accepted: 02/20/2020] [Indexed: 12/15/2022] Open
Abstract
Pediatric spinal trauma is a broad topic with nuances specific to each anatomic region of the spinal column. The purpose of this report is to provide a brief review highlighting the most important and common clinical issues regarding the diagnosis and management of pediatric spine trauma. Detailed descriptions of imaging findings along with specific operative and nonoperative management of each fracture and dislocation type are beyond the scope of this review.
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Affiliation(s)
- Nikita G Alexiades
- Department of Neurological Surgery, Columbia University, New York, New York
| | - Frank Parisi
- Department of Neurological Surgery, Columbia University, New York, New York
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Abe Y, Yamada K, Abumi K, Iwasaki N, Sudo H. Long-Term Changes in Vertebral Morphology After Cervical Spinal Fusion in Adolescent Pediatric Patients: Retrospective Case Series with up to a Minimum 12 Years of Follow-up. World Neurosurg 2019; 122:e765-e772. [DOI: 10.1016/j.wneu.2018.10.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
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Mendenhall S, Mobasser D, Relyea K, Jea A. Spinal instrumentation in infants, children, and adolescents: a review. J Neurosurg Pediatr 2019; 23:1-15. [PMID: 30611158 DOI: 10.3171/2018.10.peds18327] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVEThe evolution of pediatric spinal instrumentation has progressed in the last 70 years since the popularization of the Harrington rod showing the feasibility of placing spinal instrumentation into the pediatric spine. Although lacking in pediatric-specific spinal instrumentation, when possible, adult instrumentation techniques and tools have been adapted for the pediatric spine. A new generation of pediatric neurosurgeons with interest in complex spine disorder has pushed the field forward, while keeping the special nuances of the growing immature spine in mind. The authors sought to review their own experience with various types of spinal instrumentation in the pediatric spine and document the state of the art for pediatric spine surgery.METHODSThe authors retrospectively reviewed patients in their practice who underwent complex spine surgery. Patient demographics, operative data, and perioperative complications were recorded. At the same time, the authors surveyed the literature for spinal instrumentation techniques that have been utilized in the pediatric spine. The authors chronicle the past and present of pediatric spinal instrumentation, and speculate about its future.RESULTSThe medical records of the first 361 patients who underwent 384 procedures involving spinal instrumentation from July 1, 2007, to May 31, 2018, were analyzed. The mean age at surgery was 12 years and 6 months (range 3 months to 21 years and 4 months). The types of spinal instrumentation utilized included occipital screws (94 cases); C1 lateral mass screws (115 cases); C2 pars/translaminar screws (143 cases); subaxial cervical lateral mass screws (95 cases); thoracic and lumbar spine traditional-trajectory and cortical-trajectory pedicle screws (234 cases); thoracic and lumbar sublaminar, subtransverse, and subcostal polyester bands (65 cases); S1 pedicle screws (103 cases); and S2 alar-iliac/iliac screws (56 cases). Complications related to spinal instrumentation included hardware-related skin breakdown (1.8%), infection (1.8%), proximal junctional kyphosis (1.0%), pseudarthroses (1.0%), screw malpositioning (0.5%), CSF leak (0.5%), hardware failure (0.5%), graft migration (0.3%), nerve root injury (0.3%), and vertebral artery injury (0.3%).CONCLUSIONSPediatric neurosurgeons with an interest in complex spine disorders in children should develop a comprehensive armamentarium of safe techniques for placing rigid and nonrigid spinal instrumentation even in the smallest of children, with low complication rates. The authors' review provides some benchmarks and outcomes for comparison, and furnishes a historical perspective of the past and future of pediatric spine surgery.
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Affiliation(s)
- Stephen Mendenhall
- 1Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | - Dillon Mobasser
- 1Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
| | | | - Andrew Jea
- 1Section of Pediatric Neurosurgery, Riley Hospital for Children, Department of Neurological Surgery, Indiana University School of Medicine, Goodman Campbell Brain and Spine, Indianapolis, Indiana; and
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Surgical Treatment of Lower Cervical Fracture-Dislocation with Spinal Cord Injuries by Anterior Approach: 5- to 15-Year Follow-Up. World Neurosurg 2018; 115:e137-e145. [DOI: 10.1016/j.wneu.2018.03.213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 12/19/2022]
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Kobets AJ, Komlos D, Houten JK. Congenital cervical kyphosis in an infant with Ehlers-Danlos syndrome. Childs Nerv Syst 2018; 34:1411-1415. [PMID: 29450629 DOI: 10.1007/s00381-018-3750-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/04/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Ehler-Danlos syndome (EDS) refers to a group of heritable connective tissue disorders; rare manifestations of which are cervical kyphosis and clinical myelopathy. Surgical treatment is described for the deformity in the thoracolumbar spine in adolescents but not for infantile cervical spine. Internal fixation for deformity correction in the infantile cervical spine is challenging due to the diminutive size of the bony anatomy and the lack of spinal instrumentation specifically designed for young children. We describe the first case of successful surgical treatment in an infant with a high cervical kyphotic deformity in EDS. CASE PRESENTATION A 15-month-old female with EDS presented with several months of regression in gross motor skills in all four extremities. Imaging demonstrated 45° of kyphosis from the C2-4 levels with spinal cord compression. Corrective surgery consisted of a C3 corpectomy and C2-4 anterior fusion with allograft block and anterior fixation with dual 2 × 2 hole craniofacial miniplates, supplemented by C2-4 posterior fusion using four craniofacial miniplates fixated to the lamina. Radiographs at 20 months post-surgery demonstrated solid fusion both anteriorly and posteriorly with maintenance of correction. CONCLUSIONS Ehlers-Danlos syndrome may present in the pediatric population with congenital kyphosis from cervical deformity in addition to the more commonly seen thoracolumbar deformities.
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Affiliation(s)
- Andrew J Kobets
- Department of Neurological Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, 3316 Rochambeau Avenue, First Floor, Bronx, NY, 10463, USA
| | - Daniel Komlos
- Department of Orthopedic Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA
| | - John K Houten
- Department of Orthopedic Surgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA. .,Department of Neurosurgery, Hofstra Northwell School of Medicine, 500 Hofstra Blvd, Hempstead, NY, 11549, USA. .,Department of Neurosurgery, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY, 11219, USA.
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Goldstein HE, Neira JA, Banu M, Aldana PR, Braga BP, Brockmeyer DL, DiLuna ML, Fulkerson DH, Hankinson TC, Jea AH, Lew SM, Limbrick DD, Martin J, Pahys JM, Rodriguez LF, Rozzelle CJ, Tuite GF, Wetjen NM, Anderson RCE. Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion: a multicenter study of the Pediatric Craniocervical Society. J Neurosurg Pediatr 2018; 22:81-88. [PMID: 29676682 DOI: 10.3171/2018.1.peds17551] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The long-term effects of surgical fusion on the growing subaxial cervical spine are largely unknown. Recent cross-sectional studies have demonstrated that there is continued growth of the cervical spine through the teenage years. The purpose of this multicenter study was to determine the effects of rigid instrumentation and fusion on the growing subaxial cervical spine by investigating vertical growth, cervical alignment, cervical curvature, and adjacent-segment instability over time. METHODS A total of 15 centers participated in this multi-institutional retrospective study. Cases involving children less than 16 years of age who underwent rigid instrumentation and fusion of the subaxial cervical spine (C-2 and T-1 inclusive) with at least 1 year of clinical and radiographic follow-up were investigated. Charts were reviewed for clinical data. Postoperative and most recent radiographs, CT, and MR images were used to measure vertical growth and assess alignment and stability. RESULTS Eighty-one patients were included in the study, with a mean follow-up of 33 months. Ninety-five percent of patients had complete clinical resolution or significant improvement in symptoms. Postoperative cervical kyphosis was seen in only 4 patients (5%), and none developed a swan-neck deformity, unintended adjacent-level fusion, or instability. Of patients with at least 2 years of follow-up, 62% demonstrated growth across the fusion construct. On average, vertical growth was 79% (4-level constructs), 83% (3-level constructs), or 100% (2-level constructs) of expected growth. When comparing the group with continued vertical growth to the one without growth, there were no statistically significant differences in terms of age, sex, underlying etiology, surgical approach, or number of levels fused. CONCLUSIONS Continued vertical growth of the subaxial spine occurs in nearly two-thirds of children after rigid instrumentation and fusion of the subaxial spine. Failure of continued vertical growth is not associated with the patient's age, sex, underlying etiology, number of levels fused, or surgical approach. Further studies are needed to understand this dichotomy and determine the long-term biomechanical effects of surgery on the growing pediatric cervical spine.
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Affiliation(s)
- Hannah E Goldstein
- 1Department of Pediatric Neurosurgery, Children's Hospital of New York, Columbia-Presbyterian, New York, New York
| | - Justin A Neira
- 1Department of Pediatric Neurosurgery, Children's Hospital of New York, Columbia-Presbyterian, New York, New York
| | - Matei Banu
- 1Department of Pediatric Neurosurgery, Children's Hospital of New York, Columbia-Presbyterian, New York, New York
| | - Philipp R Aldana
- 2Division of Pediatric Neurosurgery, University of Florida College of Medicine, Jacksonville, Florida
| | - Bruno P Braga
- 3Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas
| | - Douglas L Brockmeyer
- 4Department of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Michael L DiLuna
- 5Department of Pediatric Neurosurgery, Yale School of Medicine, New Haven, Connecticut
| | - Daniel H Fulkerson
- 6Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Todd C Hankinson
- 7Department of Neurosurgery, University of Colorado School of Medicine, Aurora, Colorado
| | - Andrew H Jea
- 6Department of Neurological Surgery, Goodman Campbell Brain and Spine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sean M Lew
- 8Department of Neurosurgery, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - David D Limbrick
- 9Department of Neurological Surgery, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri
| | - Jonathan Martin
- 10Department of Neurosurgery, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Joshua M Pahys
- 11Department of Orthopedic Surgery, Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Luis F Rodriguez
- 12Department of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Curtis J Rozzelle
- 13Division of Neurosurgery, Children's of Alabama, Birmingham, Alabama; and
| | - Gerald F Tuite
- 12Department of Neurosurgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Richard C E Anderson
- 1Department of Pediatric Neurosurgery, Children's Hospital of New York, Columbia-Presbyterian, New York, New York
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Vigneswaran K, Sribnick EA, Reisner A, Chern J. Correction of Progressive Severe Cervical Kyphosis in a 21-Month-Old Patient With NF1: Surgical Technique and Review of Literature. Oper Neurosurg (Hagerstown) 2018; 15:46-53. [PMID: 29087535 DOI: 10.1093/ons/opx219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 09/17/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Severe cervical kyphosis in the setting of neurofibromatosis type 1 (NF1) is a rare manifestation of the disease in the pediatric population. Dystrophic and immature bone complicate the placement of hardware necessary for surgical correction of alignment and a review of the literature yields 4 cases of pediatric patients with NF1 requiring surgical intervention in which the youngest patient was 10 yr old. OBJECTIVE To report the case of an 11-mo-old female with NF1 who presented with a plexiform cervical neurofibroma and focal cervical kyphosis. A comprehensive review of the literature and a detailed description of nonsurgical and surgical management for this patient population is described. METHODS A literature review was completed for article reviewing management of pediatric patients with cervical spine injuries and NF1. The patient's chart was reviewed and the patient was followed for a year to provide adequate follow-up. Institutional Review Board (IRB)/ethics committee approval and patient consent were neither required nor sought for this study. RESULTS The literature was reviewed, summarized, and utilized for operative planning and postoperative management. Postoperative imaging and 1-yr follow-up imaging showed anterior construct and lateral mass fusion, restoration of cervical alignment, and no neurological deficits. CONCLUSION This is the youngest reported patient to have surgical cervical kyphosis correction in the setting of NF1. A review of the literature helped develop a long-term plan and shape a novel same-day front-back-front approach to restore alignment that will be of use to teams managing these complex patients in the future.
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Affiliation(s)
| | | | - Andrew Reisner
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia
| | - Joshua Chern
- Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia
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Morota N, Ihara S, Ogiwara H, Tamura G. Surgical management of cervical spine deformity in chondrodysplasia punctata. J Neurosurg Pediatr 2017; 20:378-387. [PMID: 28799855 DOI: 10.3171/2017.5.peds16554] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Chondrodysplasia punctata (CDP), a rare skeletal dysplasia, can lead to cervical spine instability and deformity. However, an optimal neurosurgical intervention has yet to be established. Thus, a retrospective study was conducted to assess the efficacy of various surgical interventions for children with CDP. METHODS The authors retrospectively reviewed 9 cases of CDP in which cervical decompression with or without posterior fusion was performed between April 2007 and May 2016. Patient demographics, preoperative clinical conditions, radiographic findings, surgical procedures, and the postoperative course were analyzed in detail. RESULTS A total of 12 operations were carried out in 9 patients (8 male, 1 female) during the study period. The patients' ages at the initial surgery ranged from 2 months to 2 years. Seven of the children had CDPX1, 1 had CDPX2, and 1 had tibia-metacarpal type CDP (CDP-TM). The lesion occurred at the craniovertebral junction (CVJ) in 7 cases and involved a subaxial deformity in 2 cases. The initial surgery was C-1 laminectomy with occipitocervical fusion (OCF) followed by halo external fixation in 5 cases, OCF alone in 1 case, and C-1 laminectomy alone in 3 cases. Three children required additional surgery. In one of these cases, a staged operation was required because the patient's head was too small to attach a halo ring at the time of the initial procedure (C-1 laminectomy). In another case, OCF was performed 11 months after C-1 laminectomy because of intramedullary signal change on serial MRI, although the child remained asymptomatic. In the third case, additional posterior fusion was performed 17 months after an initial laminectomy and OCF due to newly developed cervical dislocation caudal to the original fusion. This last patient required a third operation 9 months after the second because of deep wound infection. Surgery improved the motor function of all 7 children with CDPX1, but 3 children who had already suffered respiratory failure preoperatively required continued respiratory support. At the time of this report, 7 of the 9 children were alive and in stable condition. One child died due to restrictive respiratory insufficiency, and another died in an accident unrelated to CDP. CONCLUSIONS Surgical decompression with or without fusion for CVJ and subaxial cervical lesions in infants and toddlers with CDP generally saves lives and increases the likelihood of motor function recovery. However, in this case series the patients' preoperative condition had a strong effect on postoperative respiratory function. The surgery was not straightforward, and a second operation was required in some cases. Nevertheless, the findings indicate that early surgical intervention for CDP with cervical involvement is feasible, suggesting that the role of neurosurgery should be reevaluated.
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Affiliation(s)
- Nobuhito Morota
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center; and
| | - Satoshi Ihara
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center; and
| | - Hideki Ogiwara
- Divison of Neurosurgery, National Center for Child Health and Development, Tokyo, Japan
| | - Goichiro Tamura
- Division of Neurosurgery, Tokyo Metropolitan Children's Medical Center; and
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Madura CJ, Johnston JM. Classification and Management of Pediatric Subaxial Cervical Spine Injuries. Neurosurg Clin N Am 2016; 28:91-102. [PMID: 27886885 DOI: 10.1016/j.nec.2016.07.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Appropriate management of subaxial spine injury in children requires an appreciation for the differences in anatomy, biomechanics, injury patterns, and treatment options compared with adult patients. Increased flexibility, weak neck muscles, and cranial disproportion predispose younger children to upper cervical injuries and spinal cord injury without radiographic abnormality. A majority of subaxial cervical spine injuries can be treated nonoperatively. Surgical instrumentation options for children have significantly increased in recent years. Future studies of outcomes for children with subaxial cervical spine injury should focus on injury classification and standardized outcome measures to ensure continued improvement in quality of care for this patient population.
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Affiliation(s)
- Casey J Madura
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 400, Birmingham, Alabama 35233, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama at Birmingham, 1600 7th Avenue South, Lowder Suite 400, Birmingham, Alabama 35233, USA.
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12
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Li ZJ, Wang Y, Xu GJ, Tian P. Is PEEK cage better than titanium cage in anterior cervical discectomy and fusion surgery? A meta-analysis. BMC Musculoskelet Disord 2016; 17:379. [PMID: 27585553 PMCID: PMC5009677 DOI: 10.1186/s12891-016-1234-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 08/24/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This meta-analysis was performed to identify the benefits and disadvantages of the PEEK cage and titanium cage. METHODS We used "cervical or cervicle", "titanium", and "polyetheretherketone or PEEK" as keywords. Medline, Embase, Cochrane Central Register of Controlled Trials and other databases were searched to identify eligible studies that were published before October 2015. In addition, the Google search engine was used to manually search for relevant journals or conference proceedings. Randomized controlled trials and non-randomized controlled trials that compared the PEEK cage and titanium cage for anterior cervical surgery were included. The meta-analysis was performed with RevMan 5.1 software. RESULTS Two randomized and two non-randomized clinical trials were retrieved with a total of 184 segments from 107 patients in the PEEK cage group and 211 segments from 128 patients in the titanium cage group. The quality assessment scores ranged from 16 to 18 with high heterogeneity. There were no differences in functional status according to the Odom criteria, fusion rate, final local segmental angle and loss of correction between the two groups. Although more subsidence occurred in the titanium cage group, the effects of loss of the local segmental angle or the whole cervical Cobb angle on cervical function in the long-term are still not clear. CONCLUSION The present meta-analysis indicated no significant difference in functional and radiographic performance between the PEEK and titanium cages, although more subsidence occurred in the titanium cage group. More high-quality studies are needed to confirm these results to offer more information for the choice in clinical practice.
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Affiliation(s)
- Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, No.154, Anshan Road, Tianjin, 300052, People's Republic of China.
| | - Yao Wang
- Department of oncological surgery, Tianjin Nankai Hospital, Tianjin Integrated Traditional Chinese and Western Medicine Hospital, No.6 Changjiang Road, Tianjin, 300100, People's Republic of China
| | - Gui-Jun Xu
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China
| | - Peng Tian
- Department of Orthopedics, Tianjin Hospital, No. 406, Jiefang Nan Road, Tianjin, 300211, People's Republic of China
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