Department of Neurosurgery, Great Ormond Street Hospital, 34 Great Ormond Street, London, WC1N 3JH, UK.
Eur Spine J. 2020 May;29(5):961-969. doi: 10.1007/s00586-020-06313-x. Epub 2020 Feb 3.
Whilst rigid fixation for craniovertebral instability is the gold standard, in very young, small children conventional management may have to be modified. We present a single-centre experience of craniocervical fixation in children under 5 years.
A retrospective review of cases that had undergone atlantoaxial (AA) or occipitocervical (OC) fixation aged under 5 years. Fusion was assessed using computerised tomography or flexion extension X-rays.
Twenty-six children (median age 2.3, range 0.8-4.9 years, 19 under the age of 3) underwent OC (n = 19) or AA (n = 7) fusion between 1999 and 2016. Pathology comprised 17 congenital, five trauma, two tumour and two post-infection cases. Twenty-one patients underwent sublaminar cable fixation with calvarial, autologous bone graft and halo-body orthosis immobilisation. An occipital plate and rods to sublaminar wire construct were used in four cases. A rigid instrumented fixation with occipital plate and C2 pedicle screws was utilised in one case. Follow-up was for a median of 2.8 years (range 0.03-16.3 years). Initial fusion rate was 91%, reaching 100% following two re-operations. Ninety-two per cent of patients were neurologically stable or improved following surgery. Twenty-one patients had a good overall outcome. Two patients had post-operative neurological deteriorations, and four died due to non-procedure related causes. Pin site morbidity secondary to halo use occurred in five cases.
High fusion rates with good outcomes are achievable using semi-rigid fixation in the under 5-year-olds. Full thickness, autologous calvarial bone graft secured with wire cables and halo external orthosis offers a safe and effective alternative technique when traditional screw instrumentation is not feasible. These slides can be retrieved under Electronic Supplementary Material.
虽然颅颈交界区不稳定的刚性固定是金标准，但对于非常年幼的儿童，常规治疗可能需要进行修改。我们报告了一个单中心 5 岁以下儿童颅颈固定的经验。
回顾性分析了年龄在 5 岁以下接受寰枢（AA）或枕颈（OC）固定的病例。融合情况通过计算机断层扫描或屈伸位 X 线片进行评估。
1999 年至 2016 年间，26 例儿童（中位年龄 2.3 岁，范围 0.8-4.9 岁，19 岁以下）接受 OC（n=19）或 AA（n=7）融合。病变包括 17 例先天性、5 例创伤性、2 例肿瘤和 2 例感染后病例。21 例患者采用颅盖、自体骨移植物和 halo-body 矫形器固定的颅底缆索固定。4 例采用枕骨板和杆至颅底缆索结构。1 例采用枕骨板和 C2 椎弓根螺钉的刚性器械固定。中位随访时间为 2.8 年（范围 0.03-16.3 年）。初始融合率为 91%，2 次再手术后达到 100%。92%的患者术后神经稳定或改善。21 例患者总体预后良好。2 例患者术后神经恶化，4 例患者因非手术相关原因死亡。5 例患者因 halo 使用出现针道并发症。
在 5 岁以下儿童中，使用半刚性固定可实现高融合率和良好的结果。当传统螺钉器械不可行时，全厚、自体颅骨骨移植物用缆索固定和 halo 外固定矫形器是一种安全有效的替代技术。这些幻灯片可以在电子补充材料中检索。
