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“Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes
Background: The paediatric craniocervical junction has anatomical, physiological and biomechanical properties that make this region unique to that of the adult spine, vulnerable to injury, and contribute to the complexity of management. Traditionally, on-lay fusion with external Halo immobilisation...
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| Format: | Thesis |
| Language: | English |
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Division of Orthopaedic Surgery
2020
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| _version_ | 1867613253329223680 |
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| access_status_str | Open Access |
| author | Swan, Adrian Kenneth |
| author2 | Dunn, Robert N |
| author_browse | Dunn, Robert N Swan, Adrian Kenneth |
| author_facet | Dunn, Robert N Swan, Adrian Kenneth |
| author_sort | Swan, Adrian Kenneth |
| collection | Thesis |
| description | Background: The paediatric craniocervical junction has anatomical, physiological and biomechanical properties that make this region unique to that of the adult spine, vulnerable to injury, and contribute to the complexity of management. Traditionally, on-lay fusion with external Halo immobilisation has been used. Instrumented fusion offers intra-operative reduction and immediate stability. Methods: A retrospective review of a single surgeon’s prospectively maintained database was conducted for all cases of paediatric patients that had undergone a fusion involving the occipito-atlanto-axial region. Case notes were reviewed and a radiological analysis was done. Results: Sixteen patients were managed with on-lay fusion and external immobilisation and twentyseven patients were managed with internal fixation using screw-rod constructs. The fusion rates were 80% and 90.5% respectively. Allograft bone grafting was found to be a significant risk factor for non-union. Conclusion: The screws can be safely and predictably placed as confirmed on radiological follow-up with a high fusion rate and an acceptable complication rate. Uninstrumented onlay fusion with Halo immobilization remains an acceptable alternative. Allograft in the form of bone croutons or demineralised bone matrix is a significant risk factor for non-union and posterior iliac crest graft should be used preferentially. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/30853 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:33:12.104Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2020 |
| publishDateRange | 2020 |
| publishDateSort | 2020 |
| publisher | Division of Orthopaedic Surgery |
| publisherStr | Division of Orthopaedic Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/30853 “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes Swan, Adrian Kenneth Dunn, Robert N paediatric craniocervical junction occipito-atlanto-axial Harms Background: The paediatric craniocervical junction has anatomical, physiological and biomechanical properties that make this region unique to that of the adult spine, vulnerable to injury, and contribute to the complexity of management. Traditionally, on-lay fusion with external Halo immobilisation has been used. Instrumented fusion offers intra-operative reduction and immediate stability. Methods: A retrospective review of a single surgeon’s prospectively maintained database was conducted for all cases of paediatric patients that had undergone a fusion involving the occipito-atlanto-axial region. Case notes were reviewed and a radiological analysis was done. Results: Sixteen patients were managed with on-lay fusion and external immobilisation and twentyseven patients were managed with internal fixation using screw-rod constructs. The fusion rates were 80% and 90.5% respectively. Allograft bone grafting was found to be a significant risk factor for non-union. Conclusion: The screws can be safely and predictably placed as confirmed on radiological follow-up with a high fusion rate and an acceptable complication rate. Uninstrumented onlay fusion with Halo immobilization remains an acceptable alternative. Allograft in the form of bone croutons or demineralised bone matrix is a significant risk factor for non-union and posterior iliac crest graft should be used preferentially. 2020-01-31T13:48:47Z 2020-01-31T13:48:47Z 2019 2020-01-24T08:55:06Z Master Thesis Masters MMed http://hdl.handle.net/11427/30853 eng application/pdf Division of Orthopaedic Surgery Faculty of Health Sciences |
| spellingShingle | paediatric craniocervical junction occipito-atlanto-axial Harms Swan, Adrian Kenneth “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes |
| thesis_degree_str | Master's |
| title | “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes |
| title_full | “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes |
| title_fullStr | “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes |
| title_full_unstemmed | “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes |
| title_short | “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes |
| title_sort | out with the old and in with the new a retrospective review of paediatric craniocervical junction fixation indications techniques and outcomes |
| topic | paediatric craniocervical junction occipito-atlanto-axial Harms |
| url | http://hdl.handle.net/11427/30853 |
| work_keys_str_mv | AT swanadriankenneth outwiththeoldandinwiththenewaretrospectivereviewofpaediatriccraniocervicaljunctionfixationindicationstechniquesandoutcomes |