Occiput-to-Pelvis Spinal Arthrodesis: A Case Series

Area of Science:

• Orthopedic Surgery
• Pediatric Spine Deformity
• Spinal Arthrodesis

Background:

• Extensive spinal deformities in pediatric patients often require complex surgical interventions.
• Occiput-to-pelvis (O-P) spinal arthrodesis is a challenging procedure with limited published data, particularly in pediatric populations.
• Understanding the indications, operative course, and outcomes is crucial for managing these complex cases.

Observation:

• This retrospective case series analyzed eight pediatric patients who underwent staged O-P spinal arthrodesis between 1987 and 2017.
• Patients had underlying neuromuscular or syndromic disorders, with a mean age of 9.7 years at the initial surgery.
• The procedures involved a mean of three operations, with occipitocervical arthrodesis being the final stage in most cases.

Findings:

• Two patients required revision surgery for implant issues or pseudarthrosis; however, no postoperative infections or new neurologic deficits occurred.
• Long-term follow-up (mean 8.5 years) demonstrated satisfactory radiographic outcomes and maintenance of spinal correction.
• Patient-reported outcomes showed the lowest scores for Function (2.6/5) and highest for Satisfaction (4.1/5) on the SRS-22r questionnaire.

Implications:

• O-P spinal arthrodesis can be a viable option for select pediatric patients with severe spinal deformities.
• The young age at initial surgery may indicate a higher risk for progressive deformity in other spinal regions.
• Further research is warranted to optimize surgical timing and techniques for improved functional outcomes in this population.