The Journal of Bone and Joint Surgery, Vol 77, Issue 8 1234-1240, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Occipitocervical arthrodesis in children. A new technique and analysis of results
JP Dormans, DS Drummond, LN Sutton, ML Ecker and KJ Kopacz
Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA.
A new wiring technique for occipitocervical arthrodesis was used in sixteen
consecutive children between 1985 and 1992. The twelve boys and four girls
had an average age of nine years and six months (range, two years and five
months to nineteen years and three months) at the operation. The
arthrodesis was performed between the occiput and the second cervical
vertebra in ten patients and between the occiput and the third cervical
vertebra in six. The instability was related to congenital anomalies (six
patients), decompression for cervical stenosis (four patients), Down
syndrome (three patients), trauma (one patient), resection of a tumor (one
patient), and neurofibromatosis (one patient). Six patients needed a
laminectomy for decompression because of cervical stenosis or for removal
of a tumor. All of the patients were managed with an autogenous bone graft
from the iliac crest and postoperative immobilization with a halo device.
Fusion was achieved in fifteen of the sixteen patients. Complications
developed in seven patients. The use of wire fixation, combined with the
inherent stability of the bone-graft construct, allowed for removal of the
halo device relatively early (range, six to twelve weeks), before the
fusion was fully mature. No graft was displaced. All of the patients were
followed at least until there was radiographic evidence of fusion (fifteen
patients) or until a reoperation was performed (one patient). The average
duration of follow-up was thirty-seven months (range, twelve to 108
months).
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