Dataset Information

Modern instrumentation of the pediatric occiput and upper cervical spine: review article.

ABSTRACT:

Background

Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical techniques is paramount to surgical safety in pediatric patients.

Questions/purposes

This review article serves as an educational tool regarding the use of modern posterior instrumentation techniques for pediatric cervical deformity.

Methods

Expert review based on clinical expertise and literature review.

Results

The use of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine is discussed. Preoperative imaging requirements for pediatric patients undergoing cervical spine surgery are reviewed. Anatomy, morphologic studies, and surgical techniques are discussed for each area of instrumentation.

Conclusions

Modern posterior cervical instrumentation techniques can be safely applied to the majority of pediatric patients who require an instrumented posterior cervical fusion. Patient safety revolves around thorough preoperative imaging tests, understanding of upper cervical anatomy, and meticulous surgical technique. Modern instrumentation leads to an improvement in fusion rates and a diminishment in immobilization requirements.

SUBMITTER: Hedequist D

PROVIDER: S-EPMC4342396 | biostudies-literature | 2015 Feb

REPOSITORIES: biostudies-literature

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Publications

Modern instrumentation of the pediatric occiput and upper cervical spine: review article.

Hedequist Daniel D

HSS journal : the musculoskeletal journal of Hospital for Special Surgery 20140812 1

<h4>Background</h4>Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical ...[more]

PMID: 25737663

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Project description:PurposePedicle screw fixation in the upper cervical spine is a difficult and high-risk procedure. The screw is difficult to place rapidly and accurately, and can lead to serious injury of spinal cord or vertebral artery. The aim of this study was to design an individualized 3D printing navigation template for pedicle screw fixation in the upper cervical spine.MethodsUsing CT thin slices data, we employed computer software to design the navigation template for pedicle screw fixation in the upper cervical spine (atlas and axis). The upper cervical spine models and navigation templates were produced by 3D printer with equal proportion, two sets for each case. In one set (Test group), pedicle screws fixation were guided by the navigation template; in the second set (Control group), the screws were fixed under fluoroscopy. According to the degree of pedicle cortex perforation and whether the screw needed to be refitted, the fixation effects were divided into 3 types: Type I, screw is fully located within the vertebral pedicle; Type II, degree of pedicle cortex perforation is <1 mm, but with good internal fixation stability and no need to renovate; Type III, degree of pedicle cortex perforation is >1 mm or with the poor internal fixation stability and in need of renovation. Type I and Type II were acceptable placements; Type III placements were unacceptable.ResultsA total of 19 upper cervical spine and 19 navigation templates were printed, and 37 pedicle screws were fixed in each group. Type I screw-placements in the test group totaled 32; Type II totaled 3; and Type III totaled 2; with an acceptable rate of 94.60%. Type I screw placements in the control group totaled 23; Type II totaled 3; and Type III totaled 11, with an acceptable rate of 70.27%. The acceptability rate in test group was higher than the rate in control group. The operation time and fluoroscopic frequency for each screw were decreased, compared with control group.ConclusionThe individualized 3D printing navigation template for pedicle screw fixation is easy and safe, with a high success rate in the upper cervical spine surgery.

Project description:ObjectiveThe objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5-10 years, 10-20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery).MethodsA total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson's chi-square or Fisher's exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility.ResultsThe intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5-10 years: 0.69 vs 10-20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5-10 years: 0.62 vs 10-20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5-10 years: 0.61 vs 10-20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36).ConclusionsThe international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.

Dataset Information

Modern instrumentation of the pediatric occiput and upper cervical spine: review article.

Background

Questions/purposes

Methods

Results

Conclusions

Publications

Modern instrumentation of the pediatric occiput and upper cervical spine: review article.

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