Wills Brian P D, Auerbach Joshua D, Glotzbecker Michael P, Drummond Denis S, Dormans John P
Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.
Spine (Phila Pa 1976). 2006 Sep 15;31(20):2304-9. doi: 10.1097/01.brs.0000238974.90422.8d.
Retrospective case series.
Evaluate the change in lordosis at the occipitocervical junction occurring during growth in skeletally immature children treated with posterior occipitocervical arthrodesis versus patients skeletally mature at arthrodesis.
Posterior occipitocervical arthrodesis is often indicated for children who have instability of the upper cervical spine develop. Theoretically, in skeletally immature children, this approach retards the growth of the posterior spinal elements but allows the anterior spinal column to continue to grow with the risk of excessive lordosis of the cervical spine developing.
There were 21 children, younger than 11 years (range 1.9-10.9) at surgery and expected to have normal spinal growth, followed radiographically for an average of 6.3 years (range 2.0-12.4). Postoperative lateral neutral radiographs were compared to those at most recent follow-up to measure the change in occipitocervical angle. These results were then compared to a series of control patients who were skeletally mature at surgery.
Average overall change in lordosis at the occipitocervical junction was -4.6 degrees (range -12.8 degrees to +6.5 degrees). Average annualized change was -0.28 degrees per vertebral level per year (range -1.13 degrees to +0.67 degrees). This annualized change in angle was statistically significant compared to the average change of +0.01 degrees (range -0.09 degrees to +0.11 degrees) measured in the control series of patients skeletally mature at surgery (P = 0.01).
Increasing lordosis occurs at the occipitocervical junction following fusion in skeletally immature children. If occipitocervical arthrodesis is indicated in a skeletally immature child, fusion in excessive extension and overtightening of posterior wires should be avoided.
回顾性病例系列研究。
评估接受后路枕颈关节融合术治疗的骨骼未成熟儿童在生长过程中枕颈交界处脊柱前凸的变化，并与融合时骨骼成熟的患者进行比较。
后路枕颈关节融合术常用于治疗上颈椎不稳的儿童。理论上，对于骨骼未成熟的儿童，这种方法会阻碍脊柱后部结构的生长，但允许脊柱前柱继续生长，从而有发生颈椎过度前凸的风险。
21例手术时年龄小于11岁（范围1.9 - 10.9岁）且预期脊柱生长正常的儿童，接受了平均6.3年（范围2.0 - 12.4年）的影像学随访。将术后中立位侧位X线片与最近一次随访时的片子进行比较，以测量枕颈角的变化。然后将这些结果与一组手术时骨骼成熟的对照患者进行比较。
枕颈交界处脊柱前凸的平均总体变化为-4.6度（范围-12.8度至+6.5度）。平均每年变化为每个椎体水平-0.28度/年（范围-1.13度至+0.67度）。与手术时骨骼成熟的对照患者系列中测量的平均变化+0.01度（范围-0.09度至+0.11度）相比，这种角度的年变化具有统计学意义（P = 0.01）。
骨骼未成熟儿童融合后枕颈交界处的脊柱前凸会增加。如果对骨骼未成熟的儿童进行枕颈关节融合术，应避免在过度伸展位融合以及后路钢丝过度收紧。
