Outcomes of Surgical Correction of Atlantoaxial Instability in Patients with Down Syndrome: Systematic Review and Meta-Analysis

World Neurosurgery
Ryan C HoflerG Alexander Jones

Abstract

Atlantoaxial instability (AAI) is a common cause of neurologic dysfunction and pain in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. Despite this, optimal treatment strategy is controversial. A systematic review of the literature was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement to identify patients with AAI and DS were treated with upper cervical spine fusion. Patient demographics, preoperative symptoms, fixation type, and outcome measures including complications, neurologic outcomes, and bony fusion status were gathered for patients in the included publications. Meta-analysis was performed to compare outcomes of different types of fixation constructs. Of the 1191 publications retrieved, 51 met inclusion criteria, yielding 137 patients. Six fixation strategies were identified: noninstrumented (n = 6), wiring (n = 77), wiring with rods (n = 14), screw fixation (n = 33), hook and rod fixation (n = 2), and screw and wire fixation (n = 5). Constructs with screws and rods had greater bony union (P = 0.003) and a lower rate of revision surgery (P = 0.047), loss of reduction or pseudoarthrosis (P = 0.009), halo utilizatio...Continue Reading

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Citations

Nov 20, 2019·Journal of Pediatric Orthopedics·Nora P O'NeillDaniel J Hedequist
Aug 17, 2019·Journal of Neurosurgery. Pediatrics·Bram P VerhofsteDaniel J Hedequist

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