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Clinical Efficacy of an Innovative Multidimensional Traction Therapy in Moderate Adolescent Idiopathic Scoliosis

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Occipitocervicothoracic stabilization in pediatric patients.

Kyle M Fargen¹, Richard C E Anderson, David H Harter

¹Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida 32610, USA. kyle.fargen@neurosurgery.ufl.edu

Journal of Neurosurgery. Pediatrics

|July 5, 2011

Summary

Occipitocervicothoracic fixation can stabilize severe pediatric spinal deformities, potentially improving neurological function. This complex procedure requires careful consideration due to potential long-term impacts on cervical motion.

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Area of Science:

Pediatric Orthopedics
Spinal Surgery
Neurosurgery

Background:

Severe cervical spine deformities and instability in children are rare but may necessitate occipitocervicothoracic instrumentation and fusion.
Occipitocervical fixation is the primary treatment for craniocervical instability threatening neurological function.

Observation:

A retrospective review of 13 pediatric patients (ages 1-14) across 4 centers undergoing occipitocervicothoracic fixation was conducted.
Diagnoses included Klippel-Feil, Larsen, Morquio, and VATER syndromes, postlaminectomy kyphosis, and skeletal dysplasia.
Nine patients presented with myelopathy, while four were neurologically intact.

Findings:

Patients underwent various surgical approaches, including preoperative traction and combined anterior-posterior reconstruction.
Fusion was confirmed in 9 patients via CT scan; follow-up ranged from 0 to 43 months.
Myelopathy improved or stabilized in affected patients. One patient experienced mild postoperative weakness, and another died from a tracheostomy infection. Severe movement restriction was observed in all patients.

Implications:

Occipitocervicothoracic stabilization is a viable option for complex pediatric spinal deformities, potentially preserving or enhancing neurological function.
The long-term consequences of restricted cervical motion following this extensive fusion require further investigation.
Careful surgical planning is crucial to balance spinal stability with functional outcomes in pediatric patients.