Faculty Collaboration Database

Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients: Lessons Learned From a Retrospective Pediatric Craniocervical Society Study. Spine (Phila Pa 1976) 2018 Jun 01;43(11):754-760

Date

12/01/2017

Pubmed ID

29189644

DOI

10.1097/BRS.0000000000002495

Scopus ID

2-s2.0-85048080582 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

STUDY DESIGN: Multicenter retrospective cohort study with multivariate analysis.

OBJECTIVE: To determine factors predictive of posterior atlantoaxial fusion failure in pediatric patients.

SUMMARY OF BACKGROUND DATA: Fusion rates for pediatric posterior atlantoaxial arthrodesis have been reported to be high in single-center studies; however, factors predictive of surgical non-union have not been identified by a multicenter study.

METHODS: Clinical and surgical details for all patients who underwent posterior atlantoaxial fusion at seven pediatric spine centers from 1995 to 2014 were retrospectively recorded. The primary outcome was surgical failure, defined as either instrumentation failure or fusion failure seen on either plain x-ray or computed tomography scan. Multiple logistic regression analysis was undertaken to identify clinical and technical factors predictive of surgical failure.

RESULTS: One hundred thirty-one patients met the inclusion criteria and were included in the analysis. Successful fusion was seen in 117 (89%) of the patients. Of the 14 (11%) patients with failed fusion, the cause was instrumentation failure in 3 patients (2%) and graft failure in 11 (8%). Multivariate analysis identified Down syndrome as the single factor predictive of fusion failure (odds ratio 14.6, 95% confidence interval [3.7-64.0]).

CONCLUSION: This retrospective analysis of a multicenter cohort demonstrates that although posterior pediatric atlantoaxial fusion success rates are generally high, Down syndrome is a risk factor that significantly predicts the possibility of surgical failure.

LEVEL OF EVIDENCE: 3.

Author List

Brockmeyer DL, Sivakumar W, Mazur MD, Sayama CM, Goldstein HE, Lew SM, Hankinson TC, Anderson RCE, Jea A, Aldana PR, Proctor M, Hedequist D, Riva-Cambrin JK, Pediatric Craniocervical Society

Author

Sean Lew MD Chief, Professor in the Neurosurgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Atlanto-Axial Joint
Child
Child, Preschool
Female
Humans
Infant
Joint Instability
Male
Retrospective Studies
Spinal Fusion
Treatment Failure
Treatment Outcome
Young Adult