Characterizing pediatric cervical fusion in the modern era: indications, complications, and fusion rates.

IF 2.1 3区 医学 Q3 CLINICAL NEUROLOGY
Alan R Tang, Tyler Zeoli, Anthony E Bishay, James L Rogers, Georgina E Sellyn, Campbell Liles, Christopher M Bonfield
{"title":"Characterizing pediatric cervical fusion in the modern era: indications, complications, and fusion rates.","authors":"Alan R Tang, Tyler Zeoli, Anthony E Bishay, James L Rogers, Georgina E Sellyn, Campbell Liles, Christopher M Bonfield","doi":"10.3171/2024.8.PEDS24122","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Cervical fusion within the pediatric population presents unique challenges, because pediatric cervical fixation demands careful consideration of anatomical size, physiological differences, and significant prospective growth potential for young patients. In the present systematic review, the authors outline the indications for cervical fusion, summarize patient outcomes in the pediatric population, and characterize the various cervical fixation surgical techniques.</p><p><strong>Methods: </strong>A retrospective literature review of pediatric cervical fusion was conducted in June 2024 via PubMed, in accordance with PRISMA guidelines and using appropriate search syntax and evidence schemes. The initial literature search yielded 1107 articles, with 259 articles undergoing a full-text review. Inclusion criteria included studies examining pediatric populations (age ≤ 18 years) requiring cervical spine surgical fixation between 2000 and 2024. Studies in which patients with cervical pathology were not surgically treated, those examining primarily adult populations > 18 years old (n = 504), case reports (n = 150), and non-English studies (n = 96) were excluded. Outcomes consisted of demographic variables, fusion rates, bone morphogenetic protein (BMP)/graft material used, and complications.</p><p><strong>Results: </strong>In total, 106 studies between 2000 and 2024 examining 2086 patients were included in the review. The most common surgical indications across all studies included atlantoaxial instability (n = 49, 48.5%). Most studies reported cases involving occipitocervical (OC) junction pathology (n = 74, 69.8%) and using iliac crest autograft (n = 53, 50.0%) and rib autograft (n = 28, 26.4%). Allografting was used in 25 studies (23.9%) and BMP was used in 26 studies (24.5%). Overall, the fusion rate for pediatric patients undergoing cervical fusion was 95.8%, with OC fusion having comparable fusion rates (0.95 ± 0.02) to those without OC junction involvement (0.96 ± 0.01, p = 0.703). The overall complication rate was 14.9%. There were similar rates of complications compared to studies with and without OC fusion (OC: 0.15 ± 0.18, non-OC: 0.13 ± 0.17; p = 0.075).</p><p><strong>Conclusions: </strong>Despite efforts to characterize the comparative advantages of different immobilization techniques, such as screw constructs versus wiring, and the use of bone graft materials including BMP, a comprehensive understanding of outcomes remains elusive. The overall fusion rate observed in the analyzed cohort aligns with prior research, yet complications persist, with a notable proportion necessitating reoperation or revision in those with OC pathology. Although the incorporation of BMP alongside autograft and allograft materials remains relatively uncommon, the potential benefits warrant further research, with longitudinal follow-up of fusion rates.</p>","PeriodicalId":16549,"journal":{"name":"Journal of neurosurgery. Pediatrics","volume":" ","pages":"1-10"},"PeriodicalIF":2.1000,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurosurgery. Pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3171/2024.8.PEDS24122","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
引用次数: 0

Abstract

Objective: Cervical fusion within the pediatric population presents unique challenges, because pediatric cervical fixation demands careful consideration of anatomical size, physiological differences, and significant prospective growth potential for young patients. In the present systematic review, the authors outline the indications for cervical fusion, summarize patient outcomes in the pediatric population, and characterize the various cervical fixation surgical techniques.

Methods: A retrospective literature review of pediatric cervical fusion was conducted in June 2024 via PubMed, in accordance with PRISMA guidelines and using appropriate search syntax and evidence schemes. The initial literature search yielded 1107 articles, with 259 articles undergoing a full-text review. Inclusion criteria included studies examining pediatric populations (age ≤ 18 years) requiring cervical spine surgical fixation between 2000 and 2024. Studies in which patients with cervical pathology were not surgically treated, those examining primarily adult populations > 18 years old (n = 504), case reports (n = 150), and non-English studies (n = 96) were excluded. Outcomes consisted of demographic variables, fusion rates, bone morphogenetic protein (BMP)/graft material used, and complications.

Results: In total, 106 studies between 2000 and 2024 examining 2086 patients were included in the review. The most common surgical indications across all studies included atlantoaxial instability (n = 49, 48.5%). Most studies reported cases involving occipitocervical (OC) junction pathology (n = 74, 69.8%) and using iliac crest autograft (n = 53, 50.0%) and rib autograft (n = 28, 26.4%). Allografting was used in 25 studies (23.9%) and BMP was used in 26 studies (24.5%). Overall, the fusion rate for pediatric patients undergoing cervical fusion was 95.8%, with OC fusion having comparable fusion rates (0.95 ± 0.02) to those without OC junction involvement (0.96 ± 0.01, p = 0.703). The overall complication rate was 14.9%. There were similar rates of complications compared to studies with and without OC fusion (OC: 0.15 ± 0.18, non-OC: 0.13 ± 0.17; p = 0.075).

Conclusions: Despite efforts to characterize the comparative advantages of different immobilization techniques, such as screw constructs versus wiring, and the use of bone graft materials including BMP, a comprehensive understanding of outcomes remains elusive. The overall fusion rate observed in the analyzed cohort aligns with prior research, yet complications persist, with a notable proportion necessitating reoperation or revision in those with OC pathology. Although the incorporation of BMP alongside autograft and allograft materials remains relatively uncommon, the potential benefits warrant further research, with longitudinal follow-up of fusion rates.

求助全文
约1分钟内获得全文 求助全文
来源期刊
Journal of neurosurgery. Pediatrics
Journal of neurosurgery. Pediatrics 医学-临床神经学
CiteScore
3.40
自引率
10.50%
发文量
307
审稿时长
2 months
期刊介绍: Information not localiced
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信