Comparison of outcomes after occipitocervical fusion in adult versus pediatric patients: the University of Oklahoma experience.

Abstract

Objective: Occipitocervical fusion (OCF) is a well-established technique for stabilizing the craniovertebral junction in cases of trauma, congenital malformation, degenerative changes, infection, or neoplasm. Although numerous studies have evaluated outcomes in isolated adult or pediatric cohorts, no direct comparisons between these populations have been published. The authors hypothesized that OCF is better tolerated in pediatric patients, with lower complication rates and superior functional recovery.

Methods: A retrospective analysis of patients who underwent OCF between March 2021 and August 2023 at a single institution was conducted. Patients with ≥ 6 months' follow-up or those who died within 6 months of surgery were included in the analysis. The patients' clinical symptoms, radiographic fusions, complication rates, and responses to the 3-item Occipitocervical Fusion Outcomes Survey (OFOS-3) were assessed. The OFOS-3 is a novel, 3-question, patient- or parent-reported outcomes tool for evaluating pain, function, and head and neck mobility.

Results: Twenty-four patients, 11 adult and 13 pediatric, were included in this study. The mean follow-up for the patients who survived at least 6 months after surgery was 30 months (range 7-51 months). Fusion levels most commonly ranged from the occiput to C4 in adult patients and the occiput to C2 in pediatric patients, with screw lengths ranging from 6 to 24 mm and screw diameters ranging from 3.0 to 4.5 mm. Adult patients demonstrated a higher complication rate (27.3%) than pediatric patients (0%); however, complication rates were not significantly different between the two. In comparing adult and pediatric patients, the OFOS-3 overall scores were statistically different (p = 0.037), but the OFOS-3 component scores were not. CT-proven fusion was achieved in all patients who had ≥ 6 months' follow-up. There were no significant differences in non-age-related demographics (sex, indication for surgery, American Society of Anesthesiologists status), procedure-related factors (operative time, estimated blood loss, size of spinal instrumentation), and outcomes (length of stay, intensive care unit placement, OFOS-3 scores).

Conclusions: OCF appears to be safe and effective in both adult and pediatric populations, with similar surgical and functional outcomes observed. The OFOS-3 may be more sensitive at revealing clinical differences than the individual measures of pain, function, and head and neck mobility. Further prospective studies are warranted to validate the comparative findings between adult and pediatric patients, as well as the OFOS-3 instrument.