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Rigid Internal Fixation for Traumatic Cranio-Cervical Dissociation in Infants and Young Children
Joseph R Keen1, Robert E Ayer2, Asma Taha3
1Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana.
Spine
|June 13, 2018
Summary
Rigid occipito-cervical fixation safely stabilized pediatric traumatic craniocervical dissociation (tCCD), allowing some patients to regain motor function. This study supports rigid fixation in young children with tCCD.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Trauma Surgery
Background:
- Traumatic craniocervical dissociation (tCCD) is a severe injury in children, with unique challenges for surgical stabilization.
- Non-rigid fixation has been preferred in pediatric patients due to anatomical considerations, but outcomes with rigid fixation remain uncertain.
Purpose of the Study:
- To evaluate radiographic and clinical outcomes in infants and children with tCCD treated with rigid occipito-cervical fixation.
- To assess the safety and efficacy of rigid fixation in a pediatric population with traumatic craniocervical dissociation.
Main Methods:
- Retrospective review of pediatric patients (8 months to 8 years) who survived tCCD and underwent rigid occipito-cervical fixation between 2006 and 2016.
- Analysis of radiographic stability (flexion-extension X-rays) and clinical outcomes, including motor function recovery.
Main Results:
- Fifteen children with tCCD were treated with rigid posterior occipito-cervical fixation; 11 were passengers and 4 were pedestrians in motor vehicle accidents.
- Seven patients presented with neurological deficits (quadriplegia, hemiparesis, or upper extremity paresis); four showed improved motor function post-operatively.
- Fourteen patients achieved radiographic stability at a mean follow-up of 31 months, with no cases of deformity, growth disturbance, or subaxial instability.
Conclusions:
- Rigid internal rod and screw fixation is a safe and effective method for achieving long-term stability in infants and young children with tCCD.
- Children surviving tCCD can regain function following stabilization with rigid fixation.
- C2 translaminar screws are recommended for pediatric occipito-cervical instrumentation due to favorable anatomy, minimizing associated risks.
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