UPPER CERVICAL-SPINE FUSION IN THE PEDIATRIC POPULATION

The outcomes of 25 pediatric patients who underwent upper cervical or occipitocervical fusion at the authors' institution since 1983 were re viewed. At a mean age of 9 years, the patients presented with spinal i nstability that was associated with os odontoideum in 11 cases, rotato ry subluxation in five cases, odontoid fracture in two cases. atlantoo ccipital dislocation in two cases, and congenital atlantoaxial instabi lity in five patients, four of whom had Down's syndrome (trisomy 21). Ten children had abnormal findings on neurological examination preoper atively; however, nine experienced improvement or resolution of defici ts as of their latest follow-up evaluation (mean 17 months). Fusion wa s achieved with the first operation in 21 of 25 patients; eventually i t was attained in all but one. Four patients exhibited persistent spin al instability after an initial procedure. This was caused by erosion of a multistranded cable through the intact arch of C-2 in two cases, by pin site infection necessitating early halo removal in one case, an d by slippage in a halo following a Gallie procedure, which was revise d with a Brooks fusion in one case. This series, the largest yet publi shed, shows that with appropriate surgical management, posterior upper cervical fusion in the pediatric population is highly successful. Car eful attention to halo pin site care and caution in using multistrande d cable in young patients may improve results.