Single stage reduction and stabilization of basilar invagination after failed prior fusion surgery in children with Down's syndrome

Spine
Daniel HedequistMark R Proctor

Abstract

We describe an innovative single-stage reduction and stabilization technique using modern cervical instrumentation. We hypothesis modern instrumentation has made more aggressive surgical corrections possible and has reduced the need for transoral resection of the odontoid and traction reduction in children with basilar invagination. Craniocervical junction abnormalities, including atlantoaxial instability and progressive basilar invagination, are relatively common phenomenon in Down's syndrome patients, and can lead to chronic progressive neurologic deficits, catastrophic injury, and death. This patient population also can be a difficult one in which to perform successful stabilization and fusion. We reviewed the records and films on 2 children with Down's syndrome and atlantoaxial instability who had undergone prior occipital-cervical fusion and then presented with symptomatic progressive basilar invagination due to atlantoaxial displacement. In both cases, the children had progressive symptoms of spinal cord and brain stem compression. Multiple approaches for surgical correction, including preoperative traction and transoral odontoid resection, were considered, but ultimately it was elected to perform a single stage posterior...Continue Reading

References

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Citations

Jan 21, 2014·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Jincheng YangQingshui Yin
Nov 5, 2013·The Spine Journal : Official Journal of the North American Spine Society·Yi-Heng YinYuan-Zheng Zhang
Mar 5, 2015·HSS Journal : the Musculoskeletal Journal of Hospital for Special Surgery·Daniel Hedequist
Aug 10, 2011·Neurosurgery·Hormuzdiyar H DasenbrockJean-Paul Wolinsky
Aug 2, 2014·Global Spine Journal·Sun Y YangPeter G Passias
Nov 22, 2018·American Journal of Medical Genetics. Part a·Shinji TakeyariKeiichi Ozono
Apr 18, 2018·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Jian GuanFengzeng Jian

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