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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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Huneidi M, Farah K, Scavarda D, Meyer M, Fuentes S. Letter to the editor: C1-C2 fixation by Harms procedure to treat symptomatic os odontoideum in a 2-year-old child. Neurochirurgie 2023; 69:101474. [PMID: 37482185 DOI: 10.1016/j.neuchi.2023.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 07/01/2023] [Accepted: 07/06/2023] [Indexed: 07/25/2023]
Affiliation(s)
- M Huneidi
- Unité de chirurgie rachidienne, CHU Tripode Pellegrin, CHU de Bordeaux, Bordeaux, France.
| | - K Farah
- Service de neurochirurgie et de chirurgie rachidienne, assistance publique hôpitaux de Marseille, Marseille, France
| | - D Scavarda
- Service de neurochirurgie infantile, assistance publique hôpitaux de Marseille, Marseille, France
| | - M Meyer
- Service de neurochirurgie et de chirurgie rachidienne, assistance publique hôpitaux de Marseille, Marseille, France
| | - S Fuentes
- Service de neurochirurgie et de chirurgie rachidienne, assistance publique hôpitaux de Marseille, Marseille, France
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Groen JL, Peul WC, Pondaag W. Fusion rates support wired allograft combined with instrumented craniocervical fixation in the paediatric population. Acta Neurochir (Wien) 2020; 162:985-991. [PMID: 32211968 PMCID: PMC7156351 DOI: 10.1007/s00701-020-04287-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/10/2020] [Indexed: 11/24/2022]
Abstract
Background Occipitocervical and atlantoaxial instability in the pediatric population is a rare and challenging condition to treat. Variable surgical techniques have been employed to achieve fusion. The study aimed to assess bony fusion with rigid craniocervical fixation using an allograft bone block to serve as scaffold for bony fusion. Methods This is a single center case series from a tertiary referral neurosurgical center. The series includes 12 consecutive pediatric patients with rigid craniocervical fusion between 2006 and 2014. The primary outcome was bony fusion as assessed by computed tomography and flexion-extension radiographs. The authors did not receive external funding for this study. Results Twelve patients (age 1–15 years) were operated with a median imaging follow-up time of 22 months (range 6–69 m). A modified Gallie fusion technique with a tightly wired allograft bone block was used in 10 of 13 procedures. One patient underwent re-fixation due to screw breakage. Eleven out of 13 procedures resulted in a stable construct with bony fusion. All 10 patients operated with the modified Gallie fusion technique with sublaminar wiring of allograft bone block had bony fusion. No post-operative complications of the posterior fixation procedure were noted. Conclusions The modified Gallie fusion technique with allograft bone block without post-operative immobilization achieved excellent fusion. We conclude there is no need to use autograft or BMPs in craniocervical fusion in the pediatric population, which avoids related donor-site morbidity. Level of evidence Level IV—case series; therapeutic.
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Affiliation(s)
- Justus L Groen
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands
| | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, The Netherlands
| | - Willem Pondaag
- Department of Neurosurgery, Leiden University Medical Center, PO Box 9600, 2300RC, Leiden, The Netherlands.
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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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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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