Is Initial Posterior Atlantoaxial Fixation and Fusion Applying Bilateral C1-2 Transarticular Screws and C1 Laminar Hooks Reliable for Acute Pediatric Atlantoaxial Instability? A Minimal 10-Year Analysis of Outcome and Radiological Evaluation
Is Initial Posterior Atlantoaxial Fixation and Fusion Applying Bilateral C1-2 Transarticular Screws and C1 Laminar Hooks Reliable for Acute Pediatric Atlantoaxial Instability? A Minimal 10-Year Analysis of Outcome and Radiological Evaluation
复制标题
应用双侧 C1-2 经关节螺钉和 C1 层板钩进行初始后寰枢椎固定和融合对于急性儿童寰枢椎不稳是否可靠？
作者：
Guo Xiang;Han Zhao;Chen Qunxiang;Yang Jun;Chen Fei;Guo Qunfeng;Lin Peida;Ni Bin
研究设计：一项至少10年随访资料的回顾性病例系列研究。目的：验证双侧C1-2经关节螺钉、C1椎板钩和自体骨移植治疗急性小儿寰枢椎不稳的可靠性。背景资料摘要：小儿患者初次后路寰枢椎融合的可靠性仍存在争议。然而，迄今为止，只有少数已发表的文章，短期随访数据，以帮助脊柱外科医生了解后路寰枢椎融合术的影响，在napolally不成熟spinity.Methods。5例小儿急性寰枢椎不稳定进行寰枢椎融合使用上述技术超过3年的时间。在最低10年的随访期间，不仅结果和并发症进行了调查，但垂直增长的构建脊柱相对于整个颈椎的增长，整体颈椎对齐，相邻节段不稳定evaluated.Results.The临床随访表明，坚实的融合和完全临床症状缓解。未观察到神经或血管损伤。影像学评价显示，所有患者融合结构内的生长平均达到整个颈椎的35.4%。即使颈椎矢状位变直，平均C2-7角为6.4，影像学上也没有发现轴下不稳定的迹象。结论：初步后路寰枢椎融合术采用双侧C1-2经关节螺钉，C1椎板钩固定，自体骨移植是治疗急性小儿寰枢椎不稳的可靠手术技术，对垂直生长无不良影响证据等级：3一项10年随访回顾性研究，旨在验证双侧C1-2经关节螺钉和C1椎板钩治疗急性小儿寰枢椎不稳的可靠性。结果表明，它是可靠的，患者在整个随访期间在融合节段持续生长，没有发展不稳定或相邻节段疾病。
Study Design.A retrospective case series study with at least 10 years of follow-up data.Objective.To validate the reliability of bilateral C1–2 transarticular screws and C1 laminar hooks and a bone autograft for acute pediatric atlantoaxial instability.Summary of Background Data.The reliability of initial posterior atlantoaxial fusion in pediatric patients is still controversial. To date, however, only a few published articles with short-term follow-up data are available to help spinal surgeons understand the effects of posterior atlantoaxial fusion in the skeletally immature spine.Methods.Five pediatric patients with acute atlantoaxial instability underwent atlantoaxial fusion using the above technique over a 3-year period. During a minimum 10-year follow-up period, not only outcomes and complications were investigated, but the vertical growth of the constructed spine in relation to the growth of the entire cervical spine, overall cervical spinal alignment, and adjacent-segment instability were evaluated.Results.The clinical follow-up indicated solid fusion and complete clinical relief from symptoms. No neural or vascular impairment was observed. The radiological evaluation showed that all patients had growth within the fusion construct reaching a mean 35.4% of the entire cervical spine. There were no radiological indicators of subaxial instability, even when cervical sagittal alignments became straight with a mean C2–7 angle of 6.4.Conclusion.The results showed that initial posterior atlantoaxial fusion accomplished with bilateral C1–2 transarticular screws, C1 laminar hooks fixation, and bony autograft is a reliable surgical technique for treating acute pediatric atlantoaxial instability without negative effects on vertical growth at the fused level or the stability of the subaxial spine.Level of Evidence: 3A 10-year follow-up retrospective study was conducted to validate the reliability of bilateral C1–2 transarticular screws and C1 laminar hooks for acute pediatric atlantoaxial instability. The results demonstrated that it's reliable and patients have continued growth at the fused levels throughout follow-up period without developing instability, or adjacent-segment disease.