{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T20:28:11Z","timestamp":1780086491223,"version":"3.54.0"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T00:00:00Z","timestamp":1675641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100006034","name":"University of Southern California","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100006034","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Spine Deform"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>Although the pediatric population typically has a high union rate, the cervical spine has a reputation for frequent pseduarthrosis, as high as 38% in some prior series. Our purpose was to examine the rate and risk factors for pseudarthrosis in pediatric cervical spine fusions.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Retrospective review of all patients with\u2009\u2265\u20092\u00a0years follow-up undergoing cervical spinal fusion between January 2004 and December 2019 at a tertiary pediatric hospital. Pseudarthrosis was defined as an absence of radiographic union as assessed by the attending surgeon for which revision surgery was performed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>64 patients (mean age: 8.4\u2009\u00b1\u20094.7\u00a0years) met inclusion criteria. Mean follow-up was 63.3\u2009\u00b1\u200941.4\u00a0months (range: 24\u2013187\u00a0months). 28 fusions (44%) included the occiput. 41 patients (64%) had instrumentation, while 23 patients (36%) had uninstrumented fusions. 48 (75%) patients had a halo for a mean of 97.6\u2009\u00b1\u200949.5\u00a0days. The incidence of pseudarthrosis was as follows: overall\u2009=\u20098\/64 (12.5%); posterior fusion\u2009=\u200914.8% (8\/54); anterior fusions\u2009=\u20090% (0\/4); and anteroposterior fusions\u2009=\u20090% (0\/6). The rate of pseudarthrosis was over 8 times higher in fusions involving the occiput (occipitocervical fusion: 25.0%; 7\/28 vs. cervical alone: 2.8%; 1\/36; <jats:italic>p<\/jats:italic>\u2009=\u20090.02). Although not statistically significant, the rate of pseudarthrosis was 3 times higher in uninstrumented fusions (21.7%; 5\/23) than instrumented fusions (7.3%; 3\/41) (<jats:italic>p<\/jats:italic>\u2009=\u20090.12). In patients with uninstrumented fusion to the occiput, pseudarthrosis rate was 35.7% (5\/14), which was higher compared to those who did not (6.0%; 3\/50) (<jats:italic>p<\/jats:italic>\u2009=\u20090.01). Incidence of pseudarthrosis was similar in patients who received autograft (13.0%; 7\/54) compared to allograft alone (10.0%; 1\/10) (<jats:italic>p<\/jats:italic>\u2009&gt;\u20090.999).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The pseudarthrosis rate in pediatric cervical spine fusions remained high despite frequent use of halo immobilization and autograft. Patients with uninstrumented occipitocervical fusions are at particularly high risk with more than 1 in 3 developing a pseudarthrosis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Study design<\/jats:title>\n                <jats:p>Retrospective, Comparative.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Level of Evidence<\/jats:title>\n                <jats:p>III.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s43390-023-00641-w","type":"journal-article","created":{"date-parts":[[2023,2,6]],"date-time":"2023-02-06T16:04:03Z","timestamp":1675699443000},"page":"627-633","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Rate and risk factors for pediatric cervical spine fusion pseudarthrosis: opportunity for improvement"],"prefix":"10.1007","volume":"11","author":[{"given":"Edward","family":"Compton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth D.","family":"Illingworth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Stephan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David L.","family":"Skaggs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3390-7878","authenticated-orcid":false,"given":"Lindsay M.","family":"Andras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,2,6]]},"reference":[{"issue":"6","key":"641_CR1","doi-asserted-by":"publisher","first-page":"e312","DOI":"10.1097\/BPO.0000000000001176","volume":"38","author":"BW Yang","year":"2018","unstructured":"Yang BW, Glotzbecker MP, Troy M, Proctor MR, Hresko MT, Hedequist DJ (2018) C2 Translaminar screw fixation in children. J Pediatr Orthop 38(6):e312\u2013e317","journal-title":"J Pediatr Orthop"},{"issue":"5","key":"641_CR2","doi-asserted-by":"publisher","first-page":"397","DOI":"10.3171\/2012.8.SPINE12770","volume":"17","author":"SW Hwang","year":"2012","unstructured":"Hwang SW, Gressot LV, Rangel-Castilla L et al (2012) Outcomes of instrumented fusion in the pediatric cervical spine. J Neurosurg Spine 17(5):397\u2013409","journal-title":"J Neurosurg Spine"},{"issue":"8","key":"641_CR3","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.2106\/00004623-199072080-00006","volume":"72","author":"M Letts","year":"1990","unstructured":"Letts M, Slutsky D (1990) Occipitocervical arthrodesis in children. J Bone Joint Surg Am 72(8):1166\u20131170","journal-title":"J Bone Joint Surg Am"},{"key":"641_CR4","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199907000-00017","author":"WB Rodgers","year":"1999","unstructured":"Rodgers WB, Coran DL, Emans JB, Hresko MT, Hall JE (1999) Occipitocervical fusions in children. Retrospective analysis and technical considerations. Clin Orthop Relat Res. https:\/\/doi.org\/10.1097\/00003086-199907000-00017","journal-title":"Clin Orthop Relat Res"},{"issue":"3","key":"641_CR5","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1177\/1457496913486742","volume":"102","author":"N Pakkasjarvi","year":"2013","unstructured":"Pakkasjarvi N, Mattila M, Remes V, Helenius I (2013) Upper cervical spine fusion in children with skeletal dysplasia. Scand J Surg 102(3):189\u2013196","journal-title":"Scand J Surg"},{"issue":"6","key":"641_CR6","doi-asserted-by":"publisher","first-page":"573","DOI":"10.3171\/2012.2.PEDS11371","volume":"9","author":"AH Menezes","year":"2012","unstructured":"Menezes AH (2012) Craniocervical fusions in children. J Neurosurg Pediatr 9(6):573\u2013585","journal-title":"J Neurosurg Pediatr"},{"issue":"8","key":"641_CR7","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.2106\/00004623-199508000-00014","volume":"77","author":"JP Dormans","year":"1995","unstructured":"Dormans JP, Drummond DS, Sutton LN, Ecker ML, Kopacz KJ (1995) Occipitocervical arthrodesis in children. A new technique and analysis of results. J Bone Joint Surg Am 77(8):1234\u20131240","journal-title":"J Bone Joint Surg Am"},{"issue":"8","key":"641_CR8","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1007\/s00586-014-3354-3","volume":"23","author":"B He","year":"2014","unstructured":"He B, Yan L, Xu Z, Chang Z, Hao D (2014) The causes and treatment strategies for the postoperative complications of occipitocervical fusion: a 316 cases retrospective analysis. Eur Spine J 23(8):1720\u20131724","journal-title":"Eur Spine J"}],"container-title":["Spine Deformity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-023-00641-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s43390-023-00641-w\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s43390-023-00641-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,28]],"date-time":"2023-04-28T17:44:20Z","timestamp":1682703860000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s43390-023-00641-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,6]]},"references-count":8,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["641"],"URL":"https:\/\/doi.org\/10.1007\/s43390-023-00641-w","relation":{},"ISSN":["2212-134X","2212-1358"],"issn-type":[{"value":"2212-134X","type":"print"},{"value":"2212-1358","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,6]]},"assertion":[{"value":"1 March 2022","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"31 December 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 February 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Lindsay M. Andras, MD: Eli Lilly: Stock or stock Options. Journal of Pediatric Orthopedics: Editorial or governing board. Nuvasive: Paid consultant; Paid presenter or speaker. Orthobullets: Publishing royalties, financial or material support. Pediatric Orthopaedic Society of North America: Board or committee member. Scoliosis Research Society: Board or committee member. Zimmer Biomet: Paid consultant. David L. Skaggs, MD, MMM: CHLA Foundation: Board or committee member. Grand Rounds: Paid consultant. Green Sun Medical: Stock or stock Options. Growing Spine Foundation: Board or committee member. Growing Spine Study Group: Board or committee member. Journal of Children\u2019s Orthopaedics: Editorial or governing board. Nuvasive (Co-PI, Paid to Growing Spine Foundation): Research support. Orthobullets: Editorial or governing board; Paid consultant; Stock or stock Options. Orthopedics Today: Editorial or governing board. Spine Deformity: Editorial or governing board. Wolters Kluwer Health: Publishing royalties, financial or material support. ZimmerBiomet: IP royalties; Other financial or material support; Paid consultant; Paid presenter or speaker. Zipline Medical, Inc.: Stock or stock Options. Edward Compton, Stephen Stephan, and Kenneth D. Illingworth have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Institutional Review Board has approved this study and both a waiver of consent was granted and informed consent was obtained in this registry. This study has been carried out with approval from the Institutional Review Board at Children\u2019s Hospital Los Angeles.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"A waiver of consent and HIPAA authorization were granted by the Institutional Review Board at Children\u2019s Hospital Los Angeles.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Additional declarations for articles in life science journals that report the results of studies involving humans and\/or animals: Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human and animal resources"}}]}}