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.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00381-017-3497-8/MediaObjects/381_2017_3497_Fig1_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00381-017-3497-8/MediaObjects/381_2017_3497_Fig2_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00381-017-3497-8/MediaObjects/381_2017_3497_Fig3_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00381-017-3497-8/MediaObjects/381_2017_3497_Fig4_HTML.gif)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00381-017-3497-8/MediaObjects/381_2017_3497_Fig5_HTML.gif)
Similar content being viewed by others
References
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
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
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
Banwart JC, Asher MA, Hassanein RS (1995) Iliac crest bone graft harvest donor site morbidity: a statistical evaluation. Spine 20:1055–1060
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
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
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
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
Geremia GK, Kim KS, Cerullo L, Calenjoff L (1985) Complications of sublaminar wiring. Surg Neurol 6:629–635
Hedequist DJ (2014) Modern posterior screw techniques in the pediatric cervical spine. World J Orthop 5:94–99
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest.
Electronic supplementary material
ESM 1
(DOC 28 kb)
Rights and permissions
About this article
Cite this article
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
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-017-3497-8