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Non-operative management of traumatic occipitocervical distraction injuries in children: a systematic review
Luiz Carlos Almeida da Silva1, Brynn Rankin2, Markus J Bookland3,4,5
1Division of Orthopedics, Connecticut Children's, Hartford, CT, USA.
Insights
Non-operative management is safe and effective for occipitocervical distraction injuries (OCDI). This systematic review found high success rates without neurological decline, challenging existing fusion recommendations.
Area of Science:
- Orthopedic Surgery
- Pediatric Traumatology
- Neurosurgery
Background:
- Atlanto-occipital dislocation (AOD) guidelines recommend occipitocervical fusion (OCF).
- Recent literature questions OCF, highlighting successful non-operative management for occipitocervical junction (OCJ) injuries.
- Occipitocervical distraction injuries (OCDI) represent a broader spectrum of OCJ trauma.
Purpose of the Study:
- To systematically review literature on non-operative management of pediatric traumatic OCDI.
- To assess the safety and efficacy of non-operative approaches for OCDI.
- To inform future research on OCDI treatment protocols.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Inclusion of English-language publications.
- Focus on pediatric traumatic OCDI managed non-operatively.
Main Results:
- 40 patients from 21 manuscripts met inclusion criteria.
- 82.5% of patients achieved successful non-operative management.
- No neurological decline observed during follow-up (minimum 3 months).
Conclusions:
- Non-operative management is a safe and effective strategy for OCDI.
- Evidence supports challenging traditional OCF recommendations for OCDI.
- Further research is needed for standardized diagnostic and treatment protocols.
Purpose:
Existing guidelines for the management of atlanto-occipital dislocation (AOD) recommend occipitocervical fusion (OCF) for these low frequency, high-consequence injuries. Recent literature has questioned this guidance and provided case examples of successful non-operative management of a more inclusive and broadly defined spectrum of injuries to the occipitocervical junction (OCJ) termed occipitocervical distraction injuries (OCDI). A systematic review of existing literature on this topic would inform efforts to investigate the safety and efficacy of non-operative management of these injuries.
Methods:
We performed a systematic review based on preferred reporting items for systematic reviews (PRISMA) guidelines of English language publications to define and map literature related to non-operative management of pediatric traumatic OCDI.
Results:
We identified 40 patients in 21 manuscripts meeting defined inclusion and exclusion criteria. 82.5% of patients were successfully managed with non-operative management alone. No patient declined neurologically during orthotic treatment or in relation to crossover to surgical management through a minimum of 3-month follow-up.
Conclusions:
This review supports the contention that non-operative management is both safe and effective in the management of OCDI. Further research to develop standardized diagnostic and treatment protocols for non-operative management of OCDI through registries and multi-center research efforts is needed.
