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Instrumented fusion in a 12-month-old with atlanto-occipital dislocation: case report and literature review of infant occipitocervical fusion

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Abstract

Background

The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy.

Discussion

We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses.

Illustrative case

We present the case of a 12-month-old who underwent instrumented occipitocervical (OC) fusion in the setting of traumatic atlanto-occipital dislocation (AOD).

Conclusion

Occipitocervical (OC) arthrodesis is obtainable in very young infants and children. Surgical approaches are variable and use a combination of autologous grafting and creative screw and/or wire constructs. The heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management.

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References

  1. Anderson R, Kan P, Gluf WM, Brockmeyer DL (2006) Long-term maintenance of cervical alignment after occipitocervical and atlantoaxial screw fixation in young children. J Neurosurg Pediatr 105:55–61

    Article  Google Scholar 

  2. Anderson R, Ragel BT, Mocco J, Bohman L, Brockmeyer DL (2007) Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg Pediatr 107:36–42

    Article  Google Scholar 

  3. Astur N, Klimo P Jr, Sawyer JR, Kelly DM, Muhlbauer MS, Warner WC Jr (2013) Traumatic atlanto-occipital dislocation in children. J Bone Joint Surg Am 194:1–8

    Google Scholar 

  4. Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine 20:1055–1060

    Article  CAS  PubMed  Google Scholar 

  5. Bauman JA, Hardesty DA, Heuer GG, Storm PB (2011) Use of occipital bone graft in pediatric posterior cervical fusion: an alternative paramedian technique and review of the literature. J Neurosurg Pediatr 7:475–481

    Article  PubMed  Google Scholar 

  6. Benzel EC, Zhang DH, Iannotti C, Refai D, Ruggieri P, Krishnaney A (2012) Occipitocervical fusion in an infant with atlantooccipital dislocation. World Neurosurg 78:715.E17–715.E24

    Google Scholar 

  7. Cohen MW, Drummond DS, Flynn JM, Pill SG, Dormans JP (2001) A technique of occipitocervical arthrodesis in children using autologous rib grafts. Spine 36:825–829

    Article  Google Scholar 

  8. Couture D, Avery N, Brockmeyer DL (2010) Occipitocervical instrumentation in the pediatric population using a custom loop construct: initial results and long-term follow-up experience. J Neurosurg Pediatr 5:285–291

    Article  PubMed  Google Scholar 

  9. Geremia GK, Kim KS, Cerullo L, Calenjoff L (1985) Complications of sublaminar wiring. Surg Neurol 6:629–635

    Article  Google Scholar 

  10. Hedequist DJ (2014) Modern posterior screw techniques in the pediatric cervical spine. World J Orthop 5:94–99

    Article  PubMed  PubMed Central  Google Scholar 

  11. Hwang SW, Gressot LV, Chern JJ, Relyea K, Jea A (2012) Complications of occipital screw placement for occipitocervical fusion in children. J Neurosurg Pediatr 9:586–593

    Article  PubMed  Google Scholar 

  12. Ji GY, Oh CH, Park SH, Kurniawan F, Lee J, Jeon JK, Shin DA, Kim KN (2011) Feasibility of translaminar screw placement in Korean population: morphometric analysis of cervical spine. Yonsei Med J 56:159–166

    Article  Google Scholar 

  13. Klimo P Jr, Astur N, Gabrick K, Warner WC, Muhlbauer MS (2013) Occipitocervical fusion using a contoured rod and wire construct: a reappraisal of a vintage technique. J Neurosurg Pediatr 11:160–169

    Article  PubMed  Google Scholar 

  14. Martinez-del-Campo E, Turner JD, Kalb S, Rangel-Castilla L, Perez-Orribo L, Soriano-Baron H et al (2016) Occipitocervical fixation: a single surgeon’s experience with 120 patients. Neurosurgery 0:1–12

    Google Scholar 

  15. Mazur MD, Sivakumar W, Riva-Cambrin J, Jones J, Brockmeyer DL (2014) Avoiding early complications and reoperation during occipitocervical fusion in pediatric patients. J Neurosurg Pediatr 14:465–475

    Article  PubMed  Google Scholar 

  16. Mazur MD, Ravindra VM, Brockmeyer DL (2015) Unilateral fixation for treatment of occipitocervical instability in children with congenital vertebral anomalies of the craniocervical junction. Neurosurg Focus 38:1–6

    Article  Google Scholar 

  17. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6:e1000097. doi:10.1371/journal.pmed1000097

    Article  PubMed  PubMed Central  Google Scholar 

  18. Molinari RW, Molinari C (2016) The use of bone morphogenetic protein in pediatric cervical spine fusion surgery: case reports and review of the literature. Glob Spine J 1:41–46

    Article  Google Scholar 

  19. Patel AJ, Cherian J, Fulkerson DH, Fox BD, Chern JJ, Whitehead WE, Curry DJ, Luerssn TG, Jea A (2011) Computed tomography morphometric analysis for translaminar screw fixation in the upper thoracic spine in the pediatric population. J Neurosurg Pediatr 7:383–388

    Article  PubMed  Google Scholar 

  20. Reintjes SL, Amankwah EK, Rodriguez LF, Carey CC, Tuite GF (2015) Allograft versus autograft for pediatric posterior cervical and occipito-cervical fusion: a systematic review of factors affecting fusion rate. J Neurosurg Pediatr 17:1–16

    Google Scholar 

  21. Savage JG, Fulkerson DH, Sen AN, Thomas JG, Jea A (2014) Fixation with C-2 laminar screws in occipitocervical or C1-2 constructs in children 5 years of age or younger: a series of 18 patients. J Neurosurg Pediatr 14:87–93

    Article  PubMed  Google Scholar 

  22. Sayama C, Hadley C, Monaco GN, Sen A, Brayton A et al (2015) The efficacy of routine use of recombinant human bone morphogenetic protein-2 in occipitocervical and atlantoaxial fusions of the pediatric spine: a minimum of 12 months’ follow-up with computed tomography. J Neurosurg Pediatr 16:14–20

    Article  PubMed  Google Scholar 

  23. Sayama C, Willsey M, Chintagumpala M, Brayton A, Briceno V, Ryan SL et al (2015) Routine use of recombinant human bone morphogenetic protein-2 in posterior fusions of the pediatric spine and incidence of cancer. J Neurosurg Pediatr 16:4–13

    Article  PubMed  Google Scholar 

  24. Sitoula P, Mackenzie WG, Shah SA, Thacker M, Ditro C, Holmes L Jr et al (2014) Occipitocervical fusion in skeletal dysplasia. Spine 39:912–918

    Article  Google Scholar 

  25. Yamazaki M, Akazawa T, Koda M, Okawa A (2006) Surgical simulation of instrumented posterior occipitocervical fusion in a child with congenital skeletal anomaly: case report. Spine 17:590–594

    Article  Google Scholar 

  26. Xia DD, Lin SL, Chen W, Shen ZH, Li Y, Wang XY, Xu HZ, Chi YL (2014) Computed tomography morphometric analysis of C2 translaminar screw fixation of Wright’s technique and a modified technique in the pediatric cervical spine. Eur Spin J 23:606–612

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, Vanderbilt University School of Medicine, T4224 Medical Center North, Nashville, TN, 37232, USA

    Andrew T. Hale & Michael C. Dewan

  2. Division of Pediatric Neurosurgery, Monroe Carell Jr. Children’s Hospital, Nashville, TN, USA

    Andrew T. Hale & Michael C. Dewan

  3. Department of Radiology, Dell Children’s Hospital, Austin, TX, USA

    Bhairav Patel

  4. Division of Orthopedic Surgery, Dell Children’s Hospital, Austin, TX, USA

    Matthew J. Geck

  5. Division of Pediatric Neurosurgery, Dell Children’s Hospital, Austin, TX, USA

    Luke D. Tomycz

Authors
  1. Andrew T. Hale
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  2. Michael C. Dewan
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  3. Bhairav Patel
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  4. Matthew J. Geck
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  5. Luke D. Tomycz
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Corresponding author

Correspondence to Michael C. Dewan.

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The authors have no conflicts of interest.

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Hale, A.T., Dewan, M.C., Patel, B. et al. Instrumented fusion in a 12-month-old with atlanto-occipital dislocation: case report and literature review of infant occipitocervical fusion. Childs Nerv Syst 33, 1253–1260 (2017). https://doi.org/10.1007/s00381-017-3497-8

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  • DOI: https://doi.org/10.1007/s00381-017-3497-8

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