Occipitocervical fusions in children - Retrospective analysis and technical considerations

This report presents a retrospective analysis of the authors' experience wi th occipitocervical fusions in children and adolescents during the last 2 d ecades. A description of an operative technique devised by the senior autho r (JEH), and a comparison of the results using this and other methods of fu sion are given, Twenty-three patients underwent occipitocervical fusion, Fi fteen of the patients were operated on using the authors' technique, To ach ieve stable fixation of the distal cervical vertebra a threaded Kirschner w ire was passed transversely through the spinous process; occipital fixation was achieved by the traditional method of wiring corticocancellous bone gr aft to the skull through burr holes. The occipital wires then were wrapped around the Kirschner wire and the graft was cradled in the resulting nest. Halo immobilization was used in 10 patients for an average of 12.5 weeks (r ange, 6-24 weeks). Twenty-two patients achieved successful fusion at an ave rage followup of 5.8 years (range, 1-14.33 years). Several complications, i ncluding transient quadriplegia in one patient, pseudarthrosis in two (one of which persists), hardware fixation failure in one, unintended distal ext ension of the fusion, pneumonia, wound infection, halo pin infection, skin breakdown under the halo vest, hydrocephalus, cerebrospinal fluid leak, and traumatic fusion fracture were encountered. Results using the technique de scribed herein are comparable with or better than the results reported in t he previous literature, and the results of the patients in this series in w hom the technique was not used.