Related Experiment Video
Updated: Jan 3, 2026
Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
Acute Implant-related Complications in Pediatric Cervical Spine Fusion
Nora P O'Neill1, Michael T Hresko1,2, John B Emans1,2
1Department of Orthopaedic Surgery.
Insights
Acute cervical implant complications in pediatric fusion are rare (3%), but more common in patients with underlying syndromes. Early detection and surgical revision are crucial for managing these implant failures.
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Implant Technology
Background:
- Modern rigid instrumentation in pediatric cervical fusions aims to reduce implant complications.
- Acute implant-related issues, though less reported in pediatrics, persist in adult populations.
- Understanding pediatric acute cervical implant complications is vital for improving surgical outcomes.
Purpose of the Study:
- To determine the prevalence of acute implant-related complications in pediatric cervical fusion surgery.
- To identify specific types and causes of early implant failures in this population.
Main Methods:
- Retrospective review of 166 instrumented pediatric cervical fusions (August 2002 - December 2018).
- Defined acute complications as instrumentation malposition, fracture, or disengagement within 90 days.
- Analyzed patient demographics, diagnoses, complication types, and outcomes.
Main Results:
- Five patients (3%) experienced acute implant-related complications within 90 days.
- All affected patients had syndromic diagnoses (e.g., Loeys-Dietz, osteopetrosis, neurofibromatosis).
- Complications included screw protrusion, pull-out, screw-rod disengagement, and plate dislodgement, all requiring surgical revision.
Conclusions:
- The overall incidence of acute cervical implant failure in pediatric patients is low.
- Patients with underlying syndromes face a higher risk of acute implant complications.
- Intraoperative 3D CT imaging is recommended to optimize screw placement and minimize revision surgery.
Background:
The use of modern rigid instrumentation in pediatric cervical fusions decreases the risk of implant-related complications, both acute and long term. However, previous studies have indicated that acute implant-related issues still occur in the adult population. Reports of pediatric acute implant complications, occurring within 3 months of surgery, are under-represented in the literature. The purpose of this study is to document the prevalence of acute implant-related complications in a pediatric cervical fusion population.
Methods:
A retrospective review of instrumented cervical fusions from August 2002 to December 2018 was conducted. Acute implant-related complications were defined as malposition, fracture, or disengagement of cervical instrumentation, including screws, rods, and plates, within 90 days of surgery.
Results:
A total of 166 cases were included (55% male individuals) with an average age at surgery of 12.5 years (SD, ±5.28). Acute implant-related complications occurred in 5 patients (3%). All 5 patients had a syndromic diagnosis: Loeys-Dietz (n=1), osteopetrosis (n=1), neurofibromatosis (n=1), trisomy 20 (n=1), and achondroplasia (n=1). One case involved asymptomatic screw protrusion, 1 case lateral mass screw pull-out, 2 more had screw-rod disengagement, and the last experienced dislodgement of the anterior plate. The median time until the presentation was 25 days (range, 1 to 79 d). All patients (n=5) required surgical revision.
Conclusions:
This case series suggests that the overall incidence of acute cervical implant failure is low. However, failure is more likely to occur in patients with underlying syndromes compared with patients with different etiologies. Intraoperative use of 3-dimensional computed tomography imaging is recommended to evaluate the screw position and potentially avoid later surgery.
