Viers Angela G, Nguyen Khoi D, Moon Perounsack X, Forseen Scott E, Heger Ian M
1Department of Neurosurgery, Augusta University Medical Center, Augusta.
2Philadelphia College of Osteopathic Medicine Georgia Campus, Suwanee; and.
J Neurosurg Pediatr. 2019 Mar 1;23(5):634-638. doi: 10.3171/2019.1.PEDS18583. Print 2019 May 1.
Occipitocervical fusions in the pediatric population are rare but can be challenging because of the smaller anatomy. The procedure is even more exacting in patients with prior suboccipital craniectomy. A proposed method for occipitocervical fusion in such patients is the use of occipital condyle screws. There is very limited literature evaluating the pediatric occipital condyle for screw placement. The authors examined the occipital condyle in pediatric patients to determine if there was an age cutoff at which condylar screw placement is contraindicated.
The authors performed a retrospective morphometric analysis of the occipital condyle in 518 pediatric patients aged 1 week-9 years old. Patients in their first decade of life whose occipital condyle was demonstrated on CT imaging in the period from 2009 to 2013 at the Augusta University Medical Center and Children's Hospital of Georgia were eligible for inclusion in this study. Exclusion criteria were an age older than 10 years; traumatic, inflammatory, congenital, or neoplastic lesions of the occipital condyles; and any previous surgery of the occipitocervical junction. Descriptive statistical analysis was performed including calculation of the mean, standard deviation, and confidence intervals for all measurements. Probability values were calculated using the Student t-test with statistical significance determined by p < 0.05.
Overall, male patients had statistically significantly larger occipital condyles than the female patients, but this difference was not clinically significant. There was no significant difference in left versus right occipital condyles. There were statistically significant differences between age groups with a general trend toward older children having larger occipital condyles. Overall, 20.65% of all patients evaluated had at least one measurement that would prevent occipital condyle screw placement including at least one patient in every age group.
Occipital condyle screw fixation is feasible in pediatric patients younger than 10 years. More importantly, all pediatric patients should undergo critical evaluation of the occipital condyle in the axial, sagittal, and coronal planes preoperatively to determine individual suitability for occipital condyle screw placement.
小儿枕颈融合术较为罕见，但由于解剖结构较小，手术具有挑战性。对于既往有枕下颅骨切除术的患者，该手术要求更高。一种针对此类患者的枕颈融合术的建议方法是使用枕髁螺钉。评估小儿枕髁用于螺钉置入的文献非常有限。作者检查了小儿患者的枕髁，以确定是否存在髁螺钉置入禁忌的年龄界限。
作者对518例年龄在1周龄至9岁的小儿患者的枕髁进行了回顾性形态学分析。2009年至2013年期间在奥古斯塔大学医学中心和佐治亚州儿童医院，通过CT成像显示枕髁的10岁以下患者符合纳入本研究的条件。排除标准为年龄大于10岁；枕髁的创伤性、炎性、先天性或肿瘤性病变；以及既往枕颈交界区的任何手术。进行描述性统计分析，包括计算所有测量值的平均值、标准差和置信区间。使用Student t检验计算概率值，p < 0.05确定统计学显著性。
总体而言，男性患者的枕髁在统计学上显著大于女性患者，但这种差异在临床上并不显著。左右枕髁之间无显著差异。不同年龄组之间存在统计学显著差异，总体趋势是年龄较大的儿童枕髁较大。总体而言，在所有接受评估的患者中，20.65%至少有一项测量值会妨碍枕髁螺钉置入，每个年龄组至少有一名患者。
枕髁螺钉固定在10岁以下小儿患者中是可行的。更重要的是，所有小儿患者术前均应在轴向、矢状面和冠状面进行枕髁的关键评估，以确定个体是否适合枕髁螺钉置入。
