Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion

A multicenter study of the Pediatric Craniocervical Society

Hannah E. Goldstein, Justin A. Neira, Matei Banu, Philipp R. Aldana, Bruno P. Braga, Douglas L. Brockmeyer, Michael L. DiLuna, Daniel H. Fulkerson, Todd C. Hankinson, Andrew H. Jea, Sean M. Lew, David D. Limbrick, Jonathan Martin, Joshua M. Pahys, Luis F. Rodriguez, Curtis J. Rozzelle, Gerald F. Tuite, Nicholas M. Wetjen, Richard C.E. Anderson

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

OBJECTIVE: The long-term effects of surgical fusion on the growing subaxial cervical spine are largely unknown. Recent cross-sectional studies have demonstrated that there is continued growth of the cervical spine through the teenage years. The purpose of this multicenter study was to determine the effects of rigid instrumentation and fusion on the growing subaxial cervical spine by investigating vertical growth, cervical alignment, cervical curvature, and adjacent-segment instability over time. METHODS: A total of 15 centers participated in this multi-institutional retrospective study. Cases involving children less than 16 years of age who underwent rigid instrumentation and fusion of the subaxial cervical spine (C-2 and T-1 inclusive) with at least 1 year of clinical and radiographic follow-up were investigated. Charts were reviewed for clinical data. Postoperative and most recent radiographs, CT, and MR images were used to measure vertical growth and assess alignment and stability. RESULTS: Eighty-one patients were included in the study, with a mean follow-up of 33 months. Ninety-five percent of patients had complete clinical resolution or significant improvement in symptoms. Postoperative cervical kyphosis was seen in only 4 patients (5%), and none developed a swan-neck deformity, unintended adjacent-level fusion, or instability. Of patients with at least 2 years of follow-up, 62% demonstrated growth across the fusion construct. On average, vertical growth was 79% (4-level constructs), 83% (3-level constructs), or 100% (2-level constructs) of expected growth. When comparing the group with continued vertical growth to the one without growth, there were no statistically significant differences in terms of age, sex, underlying etiology, surgical approach, or number of levels fused. CONCLUSIONS: Continued vertical growth of the subaxial spine occurs in nearly two-thirds of children after rigid instrumentation and fusion of the subaxial spine. Failure of continued vertical growth is not associated with the patient's age, sex, underlying etiology, number of levels fused, or surgical approach. Further studies are needed to understand this dichotomy and determine the long-term biomechanical effects of surgery on the growing pediatric cervical spine.

Original languageEnglish (US)
Pages (from-to)81-88
Number of pages8
JournalJournal of Neurosurgery: Pediatrics
Volume22
Issue number1
DOIs
StatePublished - Jul 1 2018

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Multicenter Studies
Spine
Pediatrics
Growth
Kyphosis
Retrospective Studies
Cross-Sectional Studies

Keywords

  • Alignment
  • Cervical
  • Fusion
  • Growth
  • Stability
  • Subaxial spine

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology

Cite this

Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion : A multicenter study of the Pediatric Craniocervical Society. / Goldstein, Hannah E.; Neira, Justin A.; Banu, Matei; Aldana, Philipp R.; Braga, Bruno P.; Brockmeyer, Douglas L.; DiLuna, Michael L.; Fulkerson, Daniel H.; Hankinson, Todd C.; Jea, Andrew H.; Lew, Sean M.; Limbrick, David D.; Martin, Jonathan; Pahys, Joshua M.; Rodriguez, Luis F.; Rozzelle, Curtis J.; Tuite, Gerald F.; Wetjen, Nicholas M.; Anderson, Richard C.E.

In: Journal of Neurosurgery: Pediatrics, Vol. 22, No. 1, 01.07.2018, p. 81-88.

Research output: Contribution to journalArticle

Goldstein, HE, Neira, JA, Banu, M, Aldana, PR, Braga, BP, Brockmeyer, DL, DiLuna, ML, Fulkerson, DH, Hankinson, TC, Jea, AH, Lew, SM, Limbrick, DD, Martin, J, Pahys, JM, Rodriguez, LF, Rozzelle, CJ, Tuite, GF, Wetjen, NM & Anderson, RCE 2018, 'Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion: A multicenter study of the Pediatric Craniocervical Society', Journal of Neurosurgery: Pediatrics, vol. 22, no. 1, pp. 81-88. https://doi.org/10.3171/2018.1.PEDS17551
Goldstein, Hannah E. ; Neira, Justin A. ; Banu, Matei ; Aldana, Philipp R. ; Braga, Bruno P. ; Brockmeyer, Douglas L. ; DiLuna, Michael L. ; Fulkerson, Daniel H. ; Hankinson, Todd C. ; Jea, Andrew H. ; Lew, Sean M. ; Limbrick, David D. ; Martin, Jonathan ; Pahys, Joshua M. ; Rodriguez, Luis F. ; Rozzelle, Curtis J. ; Tuite, Gerald F. ; Wetjen, Nicholas M. ; Anderson, Richard C.E. / Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion : A multicenter study of the Pediatric Craniocervical Society. In: Journal of Neurosurgery: Pediatrics. 2018 ; Vol. 22, No. 1. pp. 81-88.
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T1 - Growth and alignment of the pediatric subaxial cervical spine following rigid instrumentation and fusion

T2 - A multicenter study of the Pediatric Craniocervical Society

AU - Goldstein, Hannah E.

AU - Neira, Justin A.

AU - Banu, Matei

AU - Aldana, Philipp R.

AU - Braga, Bruno P.

AU - Brockmeyer, Douglas L.

AU - DiLuna, Michael L.

AU - Fulkerson, Daniel H.

AU - Hankinson, Todd C.

AU - Jea, Andrew H.

AU - Lew, Sean M.

AU - Limbrick, David D.

AU - Martin, Jonathan

AU - Pahys, Joshua M.

AU - Rodriguez, Luis F.

AU - Rozzelle, Curtis J.

AU - Tuite, Gerald F.

AU - Wetjen, Nicholas M.

AU - Anderson, Richard C.E.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - OBJECTIVE: The long-term effects of surgical fusion on the growing subaxial cervical spine are largely unknown. Recent cross-sectional studies have demonstrated that there is continued growth of the cervical spine through the teenage years. The purpose of this multicenter study was to determine the effects of rigid instrumentation and fusion on the growing subaxial cervical spine by investigating vertical growth, cervical alignment, cervical curvature, and adjacent-segment instability over time. METHODS: A total of 15 centers participated in this multi-institutional retrospective study. Cases involving children less than 16 years of age who underwent rigid instrumentation and fusion of the subaxial cervical spine (C-2 and T-1 inclusive) with at least 1 year of clinical and radiographic follow-up were investigated. Charts were reviewed for clinical data. Postoperative and most recent radiographs, CT, and MR images were used to measure vertical growth and assess alignment and stability. RESULTS: Eighty-one patients were included in the study, with a mean follow-up of 33 months. Ninety-five percent of patients had complete clinical resolution or significant improvement in symptoms. Postoperative cervical kyphosis was seen in only 4 patients (5%), and none developed a swan-neck deformity, unintended adjacent-level fusion, or instability. Of patients with at least 2 years of follow-up, 62% demonstrated growth across the fusion construct. On average, vertical growth was 79% (4-level constructs), 83% (3-level constructs), or 100% (2-level constructs) of expected growth. When comparing the group with continued vertical growth to the one without growth, there were no statistically significant differences in terms of age, sex, underlying etiology, surgical approach, or number of levels fused. CONCLUSIONS: Continued vertical growth of the subaxial spine occurs in nearly two-thirds of children after rigid instrumentation and fusion of the subaxial spine. Failure of continued vertical growth is not associated with the patient's age, sex, underlying etiology, number of levels fused, or surgical approach. Further studies are needed to understand this dichotomy and determine the long-term biomechanical effects of surgery on the growing pediatric cervical spine.

AB - OBJECTIVE: The long-term effects of surgical fusion on the growing subaxial cervical spine are largely unknown. Recent cross-sectional studies have demonstrated that there is continued growth of the cervical spine through the teenage years. The purpose of this multicenter study was to determine the effects of rigid instrumentation and fusion on the growing subaxial cervical spine by investigating vertical growth, cervical alignment, cervical curvature, and adjacent-segment instability over time. METHODS: A total of 15 centers participated in this multi-institutional retrospective study. Cases involving children less than 16 years of age who underwent rigid instrumentation and fusion of the subaxial cervical spine (C-2 and T-1 inclusive) with at least 1 year of clinical and radiographic follow-up were investigated. Charts were reviewed for clinical data. Postoperative and most recent radiographs, CT, and MR images were used to measure vertical growth and assess alignment and stability. RESULTS: Eighty-one patients were included in the study, with a mean follow-up of 33 months. Ninety-five percent of patients had complete clinical resolution or significant improvement in symptoms. Postoperative cervical kyphosis was seen in only 4 patients (5%), and none developed a swan-neck deformity, unintended adjacent-level fusion, or instability. Of patients with at least 2 years of follow-up, 62% demonstrated growth across the fusion construct. On average, vertical growth was 79% (4-level constructs), 83% (3-level constructs), or 100% (2-level constructs) of expected growth. When comparing the group with continued vertical growth to the one without growth, there were no statistically significant differences in terms of age, sex, underlying etiology, surgical approach, or number of levels fused. CONCLUSIONS: Continued vertical growth of the subaxial spine occurs in nearly two-thirds of children after rigid instrumentation and fusion of the subaxial spine. Failure of continued vertical growth is not associated with the patient's age, sex, underlying etiology, number of levels fused, or surgical approach. Further studies are needed to understand this dichotomy and determine the long-term biomechanical effects of surgery on the growing pediatric cervical spine.

KW - Alignment

KW - Cervical

KW - Fusion

KW - Growth

KW - Stability

KW - Subaxial spine

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