Sitoula Prakash, Mackenzie William G, Shah Suken A, Thacker Mihir, Ditro Colleen, Holmes Laurens, Campbell Jeffrey W, Rogers Kenneth J
From the Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE.
Spine (Phila Pa 1976). 2014 Jul 1;39(15):E912-8. doi: 10.1097/BRS.0000000000000381.
Retrospective cohort study.
This study describes clinical and radiological results of a new cable technique for occipitocervical fusion (OCF) in children with skeletal dysplasia (SD).
Anatomical variability and poor bone quality make upper cervical surgery technically challenging in patients with SD. We present a new cable technique for OCF in children with SD when the posterior elements are not of a size or quality for other types of instrumentation.
Retrospective review of 24 patients with SD (8 boys, 16 girls) who underwent OCF between 2001 and 2011. In this technique, cables provide compression across a bone graft that is prevented from entering the canal and the graft resists excessive lordosis. Demographic and radiographical data are presented. All patients were followed for initial outcomes of surgery, and 20 patients (83%) were followed for 2 years or more for mid- and long-term outcomes.
Mean age at surgery was 6.5 years and mean follow-up was 4.1 ± 2.4 years. This technique was used as a primary procedure in 20 and a revision procedure in 4 patients. Diagnoses included Morquio syndrome (6), spondyloepiphyseal dysplasia (9), spondyloepimetaphyseal dysplasia (5), metatropic dysplasia (3), and Kniest syndrome (1). Ten patients had upper cervical instability and features of cervical myelopathy, and the remaining 14 patients had instability and signal changes on magnetic resonance image. Fusion extended from occiput to C2 in 71% patients, and upper cervical decompression was needed in 92% patients. Postoperatively, all patients were immobilized in a halo vest for mean duration of 12 weeks. Fusion was achieved in all patients. Complications included halo pin-tract infections (7), junctional instability (2), and extension of fusion (4).
This new cable technique is a good alternative for OCF in patients with SD who have altered anatomy at the craniocervical junction not amenable to rigid internal fixation.
回顾性队列研究。
本研究描述了一种用于骨骼发育不良（SD）儿童枕颈融合术（OCF）的新型缆线技术的临床和影像学结果。
解剖结构变异和骨质不佳使SD患者的上颈椎手术在技术上具有挑战性。当后方结构的大小或质量不适合其他类型的内固定器械时，我们为SD儿童的OCF提出了一种新的缆线技术。
回顾性分析2001年至2011年间接受OCF的24例SD患者（8例男性，16例女性）。在这项技术中，缆线对骨移植块提供加压作用，防止其进入椎管，且移植块可抵抗过度前凸。呈现了人口统计学和影像学数据。所有患者均随访手术的初始结果，20例患者（83%）随访2年或更长时间以获取中长期结果。
手术时的平均年龄为6.5岁，平均随访时间为4.1±2.4年。该技术在20例患者中作为初次手术使用，4例患者中作为翻修手术使用。诊断包括Morquio综合征（6例）、脊椎骨骺发育不良（9例）、脊椎干骺端发育不良（5例）、变异性发育不良（3例）和Kniest综合征（1例）。10例患者存在上颈椎不稳和颈髓病特征，其余14例患者存在不稳且磁共振成像有信号改变。71%的患者融合范围从枕骨延伸至C2，92%的患者需要进行上颈椎减压。术后，所有患者均使用头环背心固定，平均持续时间为12周。所有患者均实现融合。并发症包括头环针道感染（7例）、节段性不稳（2例）和融合节段延长（4例）。
对于颅颈交界处解剖结构改变且不适合刚性内固定的SD患者，这种新的缆线技术是OCF的良好替代方法。
4级。
