ARTHRODESIS OF THE CERVICAL-SPINE FOR FRACTURES AND DISLOCATIONS IN CHILDREN AND ADOLESCENTS - A LONG-TERM FOLLOW-UP-STUDY

Forty-two patients who had had an arthrodesis for instability of the c ervical spine resulting from trauma were followed clinically for a min imum of seven years (median, seventeen years and six months). The ages of the patients at the time of the injury ranged from one year and el even months to fifteen years and eleven months. On the basis of a new post-traumatic neck score, which includes an assessment of pain, mobil ity, neurological status, and function, thirty-two patients (76 per ce nt) had an excellent result, six (14 per cent) had a good result, and four (10 per cent) had a fair result. No patient had a poor result. Th ere was no notable deterioration of the clinical result with an increa sed duration of follow-up. Current radiographs of the cervical spine i n flexion and extension were available for thirty-one (74 per cent) of the forty-two patients. There was no change in stability, deformity, or the fusion mass after healing or with an increased duration of foll ow-up, but there was a significant increase in osteoarthrotic changes in the unfused segments of the cervical spine after an increased durat ion of follow-up (p = 0.0001). Complications included spontaneous exte nsion of the fusion mass in sixteen patients (38 per cent), mild pain or dysesthesias at the iliac-crest donor site in six patients (14 per cent), superficial infection at a bone-graft donor site in one patient (2 per cent), an incorrect level of arthrodesis in one patient (2 per cent), and an incomplete fusion mass in one patient (2 per cent). One patient had instability secondary to juvenile rheumatoid arthritis, w hich developed after treatment of the original injury, and she needed a reoperation. We concluded that spinal arthrodesis for fractures and dislocations of the cervical spine in children and adolescents can be accomplished safely, with an acceptable clinical outcome, a low rate o f complications, and minimum morbidity after long term follow-up. Pain , neurological status, and function do not change markedly but mobilit y may decrease with an increased duration of follow-up. Our patients h ad a decrease in mobility, associated with an increase in osteoarthrot ic changes, as seen on radiographs (p = 0.05).