Problems in Instrumentation of Syndromic Craniovertebral Junction Anomalies - Case Reports

Area of Science:

• Neurosurgery
• Pediatric Orthopedics
• Medical Device Engineering

Background:

• Syndromic craniovertebral junction (CVJ) anomalies pose unique challenges for surgical instrumentation.
• Understanding instrumentation-related complications is crucial for optimizing surgical strategies in pediatric patients.

Observation:

• Retrospective review of patients with syndromic CVJ anomalies treated between 2012-2017.
• Identification of intraoperative difficulties and complications, categorized by type (technique, neural, vascular, hardware, placement, alternative technique).

Findings:

• Four pediatric cases with syndromic CVJ anomalies experienced intraoperative complications.
• Complications included cage migration, screw penetration, fixation without a cross-connector, and intraoperative screw pullout.
• Specific diagnoses involved proatlas segmentation anomalies and Morquio-Brailsford disease.

Implications:

• Highlights the heightened risk of intraoperative complications during instrumentation for syndromic CVJ anomalies in children.
• Emphasizes the need for surgeon awareness of potential pitfalls and strategies for complication avoidance.
• Suggests refinement of surgical techniques may be necessary for improved results in this patient population.