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Rigid segmental cervical spine instrumentation is safe and efficacious in younger children
Ana Mitchell1, Vidyadhar V Upasani1,2, Carrie E Bartley2
1University of California San Diego, San Diego, CA, USA.
Insights
Cervical spine instrumentation in children under 10 is safe and effective, with rigid fixation showing good outcomes. Cervical spine wiring, however, had a high rate of non-union requiring revision surgery.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Cervical spine instrumentation in young pediatric patients is not well-documented.
- Understanding outcomes and complications is crucial for this population.
Purpose of the Study:
- To report on the outcomes and complications of cervical spine instrumentation in pediatric patients younger than 10 years.
- To evaluate the safety and efficacy of different instrumentation techniques.
Main Methods:
- Retrospective review of 20 pediatric patients (≤10 years) who underwent cervical spine fusion with instrumentation.
- Data collected included diagnosis, procedural details, imaging, and follow-up.
- Instrumentation types included 3.5-mm cervical spine instrumentation, wiring, and cannulated screws.
Main Results:
- Fifteen patients received 3.5-mm instrumentation, 3 received wiring, and 2 received cannulated screws.
- Five complications occurred: 2 non-unions with wiring (requiring revision), 1 postoperative infection, and 5 superficial halo pin infections.
- Neurological complications in 2 patients were deemed unrelated to instrumentation.
Conclusions:
- Rigid segmental fixation is safe and effective for pediatric cervical spine fusion.
- Successful fusion and minimal complications were observed with rigid fixation, regardless of immobilization method.
- Cervical spine wiring demonstrated a high risk of non-union, necessitating revision surgery.
Purpose:
The utilization of cervical spine instrumentation in the young pediatric patient is not well reported. This study presents outcomes and complications of cervical spine instrumentation in patients who underwent cervical spine fusion surgery before age 10.
Methods:
Radiographic and clinical data were collected on all patients who underwent cervical spine surgery with instrumentation at a single institution between January 1, 2006, and March 31, 2015. Patients were ≤ 10 years of age at the time of surgery with any cervical spine deformity/injury diagnosis. Patient demographics, details on cervical spine diagnosis, procedural data, imaging data, and postoperative follow-up data were collected.
Results:
Twenty children met the criteria and were included in the study with a mean follow-up of 10.6 months (3 months-2 years). Initial indication for cervical spine correction surgery included deformity (7 cases), trauma (6 cases), instability (3 cases), stenosis (2 cases), rotary subluxation (1 case), and infection (1 case). Fifteen cases were treated with adult 3.5-mm cervical spine instrumentation, 3 with wiring (1 sublaminar and 2 spinous process), and 2 with cannulated screws. Postoperative immobilization included 16 halo fixation, 3 collars, and 1 CTO. Overall, there were five complications related to the surgery. Two patients who had wiring (1 sublaminar and 1 spinous process) developed a non-union and required revision surgery (1 with cannulated screws and 1 with 3.5-mm segmental cervical spine instrumentation). One patient developed a postoperative infection that required incision and drainage. Five patients developed superficial pin infections for their halo. Two deformity patients experienced neurological complications that were likely unrelated to the cervical instrumentation.
Conclusions:
Rigid segmental fixation can be safe and efficacious when used in pediatric cervical spine patients. Whether used with halo or orthosis, patients experience minimal to no complications from the instrumentation and achieve successful fusion. Cervical spine wiring had a high risk of non-union requiring revision surgery. The incidence of wound infection was low with one in 20 cases.
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