Janjua M Burhan, Hwang Steven W, Samdani Amer F, Pahys Joshua M, Baaj Ali A, Härtl Roger, Greenfield Jeffrey P
Department of Neurological Surgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
Shriners Hospitals for Children-Philadelphia, 3551 N Broad St, Philadelphia, PA, 19140, USA.
Childs Nerv Syst. 2019 Jan;35(1):97-106. doi: 10.1007/s00381-018-3876-9. Epub 2018 Jun 29.
Occipitocervical instrumentation is infrequently required for stabilization of the axial and subaxial cervical spine in very young children. However, when it is necessary, unique surgical considerations arise in children when compared with similar procedures in adults.
The authors reviewed literature describing fusion of the occipitocervical junction (OCJ) in toddlers and share their experience with eight cases of young children (age less than or equal to 4 years) receiving occiput to axial or subaxial spine instrumentation and fixation. Diagnoses and indications included severe or secondary Chiari malformation, skeletal dysplastic syndromes, Klippel-Feil syndrome, Pierre Robin syndrome, Gordon syndrome, hemivertebra and atlantal occipitalization, basilar impression, and iatrogenic causes.
All patients underwent occipital bone to cervical spine instrumentation and fixation at different levels. Constructs extended from the occiput to C2 and T1 utilizing various permutations of titanium rods, autologous rib autografts, Mersilene sutures, and combinations of autografts with bone matrix materials. All patients were placed in rigid cervical bracing or halo fixation postoperatively. No postoperative neurological deficits or intraoperative vascular injuries occurred.
Instrumented arthrodesis can be a treatment option in very young children to address the non-traumatic craniocervical instability while reducing the need for prolonged external halo vest immobilization. Factors affecting fusion are addressed with respect to preoperative, intraoperative, and postoperative decision-making that may be unique to the toddler population.
在非常年幼的儿童中，很少需要枕颈器械来稳定颈椎的轴性和下颈椎。然而，当有必要时，与成人的类似手术相比，儿童会出现独特的手术考量。
作者回顾了描述幼儿枕颈交界融合术（OCJ）的文献，并分享了他们对8例年龄小于或等于4岁的儿童进行枕骨至颈椎或下颈椎器械固定的经验。诊断和适应症包括严重或继发性小脑扁桃体下疝畸形、骨骼发育异常综合征、Klippel-Feil综合征、Pierre Robin综合征、Gordon综合征、半椎体和寰枕融合、基底凹陷以及医源性原因。
所有患者均在不同节段进行了枕骨至颈椎的器械固定。通过钛棒、自体肋骨移植、Mersilene缝线以及自体移植与骨基质材料的各种组合，构建物从枕骨延伸至C2和T1。所有患者术后均接受了刚性颈托或头环固定。术后未出现神经功能缺损或术中血管损伤。
器械辅助关节融合术可以作为非常年幼儿童的一种治疗选择，以解决非创伤性颅颈不稳定问题，同时减少长期使用外部头环背心固定的需求。针对术前、术中和术后决策中可能对幼儿群体独特的影响融合的因素进行了探讨。
