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Craniovertebral junction fixation in children less than 5 years
Patrick J Grover1, Lauren S Harris2, Dominic N P Thompson2
1Department of Neurosurgery, Great Ormond Street Hospital, 34 Great Ormond Street, London, WC1N 3JH, UK. patrick.grover@doctors.org.uk.
Summary
Semi-rigid fixation techniques, including cable fixation with bone grafts and halo orthosis, achieve high fusion rates and good outcomes for craniovertebral instability in children under five years old. This approach offers a safe alternative when traditional methods are not feasible.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Spinal Surgery
Background:
- Craniovertebral instability in young children often requires modified management compared to adults.
- Rigid fixation is the standard, but anatomical limitations in very young patients necessitate alternative approaches.
Purpose of the Study:
- To evaluate the safety and efficacy of semi-rigid fixation techniques for craniovertebral instability in children under five years of age.
- To present a single-center experience with craniocervical fixation in this pediatric population.
Main Methods:
- Retrospective review of 26 children under five years old who underwent atlantoaxial (AA) or occipitocervical (OC) fixation.
- Fusion assessment via computed tomography or flexion-extension X-rays.
- Analysis of fixation methods, including sublaminar cable fixation, bone grafts, and halo-body orthosis.
Main Results:
- High initial fusion rate of 91%, reaching 100% after re-operations.
- 92% of patients were neurologically stable or improved post-surgery.
- Good overall outcomes in 21 patients, with manageable morbidity (e.g., pin site issues).
Conclusions:
- Semi-rigid fixation techniques provide high fusion rates and favorable outcomes in children under five with craniovertebral instability.
- Autologous calvarial bone graft secured with wire cables and halo external orthosis is a safe and effective alternative when traditional screw instrumentation is not feasible.
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