“Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes

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dc.contributor.advisorDunn, Robert N
dc.contributor.authorSwan, Adrian Kenneth
dc.date.accessioned2020-01-31T13:48:47Z
dc.date.available2020-01-31T13:48:47Z
dc.date.issued2019
dc.date.updated2020-01-24T08:55:06Z
dc.description.abstractBackground: 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.
dc.identifier.apacitationSwan, A. K. (2019). <i>“Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes</i>. (). ,Faculty of Health Sciences ,Division of Orthopaedic Surgery. Retrieved from http://hdl.handle.net/11427/30853en_ZA
dc.identifier.chicagocitationSwan, Adrian Kenneth. <i>"“Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes."</i> ., ,Faculty of Health Sciences ,Division of Orthopaedic Surgery, 2019. http://hdl.handle.net/11427/30853en_ZA
dc.identifier.citationSwan, A. 2019. “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Swan, Adrian Kenneth AB - 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. DA - 2019 DB - OpenUCT DP - University of Cape Town KW - paediatric KW - craniocervical junction KW - occipito-atlanto-axial KW - Harms LK - https://open.uct.ac.za PY - 2019 T1 - “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes TI - “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes UR - http://hdl.handle.net/11427/30853 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/30853
dc.identifier.vancouvercitationSwan AK. “Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes. []. ,Faculty of Health Sciences ,Division of Orthopaedic Surgery, 2019 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/30853en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of Orthopaedic Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.subjectpaediatric
dc.subjectcraniocervical junction
dc.subjectoccipito-atlanto-axial
dc.subjectHarms
dc.title“Out with the old and in with the new” - A retrospective review of paediatric craniocervical junction fixation: indications, techniques and outcomes
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMed
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