Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Blvd, MS #69, Los Angeles, CA, 90027, USA.
Cedar-Sinai Medical Center, Los Angeles, CA, USA.
Spine Deform. 2023 May;11(3):627-633. doi: 10.1007/s43390-023-00641-w. Epub 2023 Feb 6.
Although the pediatric population typically has a high union rate, the cervical spine has a reputation for frequent pseduarthrosis, as high as 38% in some prior series. Our purpose was to examine the rate and risk factors for pseudarthrosis in pediatric cervical spine fusions.
Retrospective review of all patients with ≥ 2 years follow-up undergoing cervical spinal fusion between January 2004 and December 2019 at a tertiary pediatric hospital. Pseudarthrosis was defined as an absence of radiographic union as assessed by the attending surgeon for which revision surgery was performed.
64 patients (mean age: 8.4 ± 4.7 years) met inclusion criteria. Mean follow-up was 63.3 ± 41.4 months (range: 24-187 months). 28 fusions (44%) included the occiput. 41 patients (64%) had instrumentation, while 23 patients (36%) had uninstrumented fusions. 48 (75%) patients had a halo for a mean of 97.6 ± 49.5 days. The incidence of pseudarthrosis was as follows: overall = 8/64 (12.5%); posterior fusion = 14.8% (8/54); anterior fusions = 0% (0/4); and anteroposterior fusions = 0% (0/6). The rate of pseudarthrosis was over 8 times higher in fusions involving the occiput (occipitocervical fusion: 25.0%; 7/28 vs. cervical alone: 2.8%; 1/36; p = 0.02). Although not statistically significant, the rate of pseudarthrosis was 3 times higher in uninstrumented fusions (21.7%; 5/23) than instrumented fusions (7.3%; 3/41) (p = 0.12). In patients with uninstrumented fusion to the occiput, pseudarthrosis rate was 35.7% (5/14), which was higher compared to those who did not (6.0%; 3/50) (p = 0.01). Incidence of pseudarthrosis was similar in patients who received autograft (13.0%; 7/54) compared to allograft alone (10.0%; 1/10) (p > 0.999).
The pseudarthrosis rate in pediatric cervical spine fusions remained high despite frequent use of halo immobilization and autograft. Patients with uninstrumented occipitocervical fusions are at particularly high risk with more than 1 in 3 developing a pseudarthrosis.
Retrospective, Comparative.
III.
尽管儿科人群的融合率通常较高，但颈椎因假关节形成而闻名，在一些先前的系列研究中高达 38%。我们的目的是研究儿童颈椎融合术后假关节形成的发生率和危险因素。
对 2004 年 1 月至 2019 年 12 月期间在一家三级儿科医院接受至少 2 年随访的所有行颈椎融合术的患者进行回顾性分析。假关节定义为手术医生评估的影像学融合缺失，需要进行翻修手术。
64 例患者（平均年龄：8.4±4.7 岁）符合纳入标准。平均随访时间为 63.3±41.4 个月（范围：24-187 个月）。28 例融合术（44%）包括枕骨。41 例（64%）有内固定，而 23 例（36%）无内固定。48 例（75%）患者接受了头环固定，平均固定时间为 97.6±49.5 天。假关节的发生率如下：总体发生率为 8/64（12.5%）；后路融合术为 14.8%（8/54）；前路融合术为 0%（0/4）；前后路联合融合术为 0%（0/6）。涉及枕骨的融合术（枕颈融合术：25.0%（7/28）与单纯颈椎融合术：2.8%（1/36））的假关节发生率高 8 倍以上（p=0.02）。尽管没有统计学意义，但无内固定融合术（21.7%（5/23））的假关节发生率是有内固定融合术（7.3%（3/41））的 3 倍（p=0.12）。在无内固定的枕骨融合术患者中，假关节发生率为 35.7%（5/14），高于未发生假关节的患者（6.0%（3/50））（p=0.01）。接受自体移植物（13.0%（7/54））与单纯同种异体移植物（10.0%（1/10））的患者的假关节发生率相似（p＞0.999）。
尽管频繁使用头环固定和自体移植物，儿童颈椎融合术后的假关节发生率仍然较高。未行内固定的枕颈融合术患者发生假关节的风险特别高，超过 1/3 的患者发生假关节。
回顾性、比较性。
III 级。
