The Journal of Bone and Joint Surgery, Vol 76, Issue 11 1606-1616, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
Arthrodesis of the cervical spine for fractures and dislocations in children and adolescents. A long-term follow-up study
BJ McGrory and RA Klassen
Department of Orthopaedics, Mayo Clinic, Rochester, Minnesota 55905.
Forty-two patients who had had an arthrodesis for instability of the
cervical spine resulting from trauma were followed clinically for a minimum
of seven years (median, seventeen years and six months). The ages of the
patients at the time of the injury ranged from one year and eleven months
to fifteen years and eleven months. On the basis of a new post-traumatic
neck score, which includes an assessment of pain, mobility, neurological
status, and function, thirty-two patients (76 per cent) had an excellent
result, six (14 per cent) had a good result, and four (10 per cent) had a
fair result. No patient had a poor result. There was no notable
deterioration of the clinical result with an increased duration of
follow-up. Current radiographs of the cervical spine in flexion and
extension were available for thirty-one (74 per cent) of the forty-two
patients. There was no change in stability, deformity, or the fusion mass
after healing or with an increased duration of follow-up, but there was a
significant increase in osteoarthrotic changes in the unfused segments of
the cervical spine after an increased duration of follow-up (p = 0.0001).
Complications included spontaneous extension of the fusion mass in sixteen
patients (38 per cent), mild pain or dysesthesias at the iliac-crest donor
site in six patients (14 per cent), superficial infection at a bone-graft
donor site in one patient (2 per cent), an incorrect level of arthrodesis
in one patient (2 per cent). One patient had instability secondary to
juvenile rheumatoid arthritis, which developed after treatment of the
original injury, and she needed a reoperation. We concluded that spinal
arthrodesis for fractures and dislocations of the cervical spine in
children and adolescents can be accomplished safely, with an acceptable
clinical outcome, a low rate of complications, and minimum morbidity after
long-term follow-up. Pain, neurological status, and function do not change
markedly, but mobility may decrease with an increased duration of
follow-up. Our patients had a decrease in mobility, associated with an
increase in osteoarthrotic changes, as seen on radiographs (p = 0.05).
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