Fusion for instability and potential instability of the cervical spine in children and adolescents

Instability and potential instability of the cervical spine in the child and adolescent not presenting as emergencies may be due to many causes. We have reviewed 30 patients treated surgically over a seven year period and have grouped them under four general headings: isolated congenital anomalies of the cervical spine, postlaminectomy instability, traumatic instability with delayed presentation, and bony or ligamentous inadequacy secondary to miscellaneous conditions. The variety of conditions permits few generalizations. However, an overview of the entire group supports the concept that abnormal motion in an immature spine or the potential for such motion should be viewed cautiously by the orthopedist, for it may herald severe neurologic compromise. When compromise has occurred, the decision to intervene is made easier. Should only increased motion or the potential for such be present, the natural history of the lesion, if available, should be the guide to treatment. If the natural history of a cervical spine lesion is not available and structural integrity is compromised with abnormal motion present, fusion is advised. Appropriate patient counseling as to the lack of an alternative, with the exception of prolonged bracing to avoid the hazards of life, is essential in this group of individuals.