Yang Brian W, Hedequist Daniel J, Proctor Mark R, Troy Michael, Hresko Michael T, Glotzbecker Michael P
Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA; Department of Neurosurgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
Spine Deform. 2019 Nov;7(6):957-961. doi: 10.1016/j.jspd.2019.03.002.
Retrospective case series.
To describe the indications and outcomes of cervical fixation using modern instrumentation in a case series of pediatric Down syndrome (DS) patients.
Cervical instability is the major cervical spine concern in children with DS. Although fixation techniques have advanced over the past quarter-century, the outcome of fixation with modern instrumentation for upper cervical instability in DS patients has not been thoroughly investigated.
We searched the orthopedic database at our institution for patients with a diagnosis of DS who had undergone a cervical spine fusion between 2006 and 2017. Patient demographics, diagnoses, surgical indications, surgical details, and complications were recorded. Preoperative imaging was reviewed to determine atlanto-dens intervals and spinal cord signal changes. Postoperative radiographs or CT scans were reviewed to determine union.
Twelve DS patients met our inclusion criteria. The mean age at surgery was 9.3 years (range 3.8-18.8 years). Patients with secondary causes of instability included 7 patients with os odontoideum and 1 patient with a pars fracture. Three patients (25%) were identified on asymptomatic screening, with none of these having cord signal changes on magnetic resonance imaging (MRI). Modern implants (screws, plates, cages) were used in every patient in our series. The mean number of levels fused was 1.9 (range 1-5). The overall complication rate was 41.7% (5/12). Four patients required repeat surgery for nonunion. All patients with adequate radiographic follow-up demonstrated union (11/11, 100%). One patient was lost to follow-up.
Fixation for cervical instability is a critical component of the management of DS. A minority of patients receiving surgery were identified through asymptomatic screening. There was a high complication risk associated with surgery in our study; however, the addition of rigid fixation has lessened the complication rate compared with previous studies.
Level IV.
回顾性病例系列研究。
描述在一组小儿唐氏综合征（DS）患者中使用现代器械进行颈椎固定的适应证和结果。
颈椎不稳是DS患儿主要的颈椎问题。尽管在过去四分之一个世纪里固定技术有所进步，但现代器械固定治疗DS患者上颈椎不稳的结果尚未得到充分研究。
我们在本机构的骨科数据库中搜索2006年至2017年间接受颈椎融合手术的DS诊断患者。记录患者的人口统计学资料、诊断、手术适应证、手术细节和并发症。回顾术前影像学检查以确定寰齿间距和脊髓信号变化。回顾术后X线片或CT扫描以确定融合情况。
12例DS患者符合我们的纳入标准。手术时的平均年龄为9.3岁（范围3.8 - 18.8岁）。不稳定的继发原因患者包括7例齿突骨患者和1例椎弓根骨折患者。3例患者（25%）是在无症状筛查中发现的，这些患者在磁共振成像（MRI）上均无脊髓信号变化。我们系列中的每位患者均使用了现代植入物（螺钉、钢板、椎间融合器）。融合节段的平均数量为1.9个（范围1 - 5个）。总体并发症发生率为41.7%（5/12）。4例患者因未融合需要再次手术。所有接受充分影像学随访的患者均显示融合（11/11，100%）。1例患者失访。
颈椎不稳的固定是DS治疗的关键组成部分。少数接受手术的患者是通过无症状筛查发现的。我们的研究中手术相关的并发症风险较高；然而，与先前的研究相比，增加坚强固定降低了并发症发生率。
IV级。
