Andrew T Hale1,2, Michael C Dewan3,4, Bhairav Patel5, Matthew J Geck6, Luke D Tomycz7. 1. Department of Neurosurgery, Vanderbilt University School of Medicine, T4224 Medical Center North, Nashville, TN, 37232, USA. 2. Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA. 3. Department of Neurosurgery, Vanderbilt University School of Medicine, T4224 Medical Center North, Nashville, TN, 37232, USA. michael.dewan@vanderbilt.edu. 4. Division of Pediatric Neurosurgery, Monroe Carell Jr. Children's Hospital, Nashville, TN, USA. michael.dewan@vanderbilt.edu. 5. Department of Radiology, Dell Children's Hospital, Austin, TX, USA. 6. Division of Orthopedic Surgery, Dell Children's Hospital, Austin, TX, USA. 7. Division of Pediatric Neurosurgery, Dell Children's Hospital, Austin, TX, USA.
Abstract
BACKGROUND: The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy. DISCUSSION: We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses. ILLUSTRATIVE CASE: We present the case of a 12-month-old who underwent instrumented occipitocervical (OC) fusion in the setting of traumatic atlanto-occipital dislocation (AOD). CONCLUSION: Occipitocervical (OC) arthrodesis is obtainable in very young infants and children. Surgical approaches are variable and use a combination of autologous grafting and creative screw and/or wire constructs. The heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management.
BACKGROUND: The treatment of atlantoaxial dislocation in very young children is challenging and lacks a consensus management strategy. DISCUSSION: We review the literature on infantile occipitocervical (OC) fusion is appraised and technical considerations are organized for ease of reference. Surgical decisions such as graft type and instrumentation details are summarized, along with the use of bone morphogenic protein and post-operative orthoses. ILLUSTRATIVE CASE: We present the case of a 12-month-old who underwent instrumented occipitocervical (OC) fusion in the setting of traumatic atlanto-occipital dislocation (AOD). CONCLUSION: Occipitocervical (OC) arthrodesis is obtainable in very young infants and children. Surgical approaches are variable and use a combination of autologous grafting and creative screw and/or wire constructs. The heterogeneity of pathologic etiology leading to OC fusion makes it difficult to make definitive recommendations for surgical management.
Authors: Christina Sayama; Matthew Willsey; Murali Chintagumpala; Alison Brayton; Valentina Briceño; Sheila L Ryan; Thomas G Luerssen; Steven W Hwang; Andrew Jea Journal: J Neurosurg Pediatr Date: 2015-04-10 Impact factor: 2.375
Authors: Paul Klimo; Nelson Astur; Kyle Gabrick; William C Warner; Michael S Muhlbauer Journal: J Neurosurg Pediatr Date: 2012-11-16 Impact factor: 2.375