{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:28:58Z","timestamp":1777591738581,"version":"3.51.4"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2011,7]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Although rarely encountered, pediatric patients with severe cervical spine deformities and instability may occasionally require occipitocervicothoracic instrumentation and fusion. This case series reports the experience of 4 pediatric centers in managing this condition. Occipitocervical fixation is the treatment of choice for craniocervical instability that is symptomatic or threatens neurological function. In children, the most common distal fixation level with modern techniques is C-2. Treated patients maintain a significant amount of neck motion due to the flexibility of the subaxial cervical spine. Distal fixation to the thoracic spine has been reported in adult case series. This procedure is to be avoided due to the morbidity of complete loss of head and neck motion. Unfortunately, in rare cases, the pathological condition or highly aberrant anatomy may require occipitocervical constructs to include the thoracic spine.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors identified 13 patients who underwent occipitocervicothoracic fixation. Demographic, radiological, and clinical data were gathered through retrospective review of patient records from 4 institutions.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Patients ranged from 1 to 14 years of age. There were 7 girls and 6 boys. Diagnoses included Klippel-Feil, Larsen, Morquio, and VATER syndromes as well as postlaminectomy kyphosis and severe skeletal dysplasia. Four patients were neurologically intact and 9 had myelopathy. Five children were treated with preoperative traction prior to instrumentation; 5 underwent both anterior and posterior spinal reconstruction. Two patients underwent instrumentation beyond the thoracic spine. Allograft was used anteriorly, and autologous rib grafts were used in the majority for posterior arthrodesis. Follow-up ranged from 0 to 43 months. Computed tomography confirmed fusion in 9 patients; the remaining patients were lost to follow-up or had not undergone repeat imaging at the time of writing. Patients with myelopathy either improved or stabilized. One child had mild postoperative unilateral upper-extremity weakness, and a second child died due to a tracheostomy infection. All patients had severe movement restriction as expected.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Occipitocervicothoracic stabilization may be employed to stabilize and reconstruct complex pediatric spinal deformities. Neurological function can be maintained or improved. The long-term morbidity of loss of cervical motion remains to be elucidated.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2011.4.peds10450","type":"journal-article","created":{"date-parts":[[2011,7,1]],"date-time":"2011-07-01T14:03:40Z","timestamp":1309529020000},"page":"57-62","source":"Crossref","is-referenced-by-count":12,"title":["Occipitocervicothoracic stabilization in pediatric patients"],"prefix":"10.3171","volume":"8","author":[{"given":"Kyle M.","family":"Fargen","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard C. E.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David H.","family":"Harter","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, New York University School of Medicine, New York, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter D.","family":"Angevine","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerie C.","family":"Coon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Brockmeyer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Pincus","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Florida College of Medicine, Gainesville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-0080057","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1007\/s00381-008-0607-7","article-title":"Fusions at the craniovertebral junction","volume":"24","author":"Ahmed","year":"2008"},{"issue":"1 Suppl","key":"b2-0080057","series-title":"J Neurosurg","first-page":"55","article-title":"Long-term maintenance of cervical alignment after occipitocervical and atlantoaxial screw fixation in young children","volume":"105","author":"Anderson","year":"2006"},{"issue":"1 Suppl","key":"b3-0080057","series-title":"J Neurosurg","first-page":"36","article-title":"Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients","volume":"107","author":"Anderson","year":"2007"},{"key":"b4-0080057","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1542\/peds.111.1.199","article-title":"Cervical spine involvement in Larsen's syndrome: a case illustration","volume":"111","author":"Banks","year":"2003"},{"key":"b5-0080057","series-title":"Spine J","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.spinee.2007.05.008","article-title":"Biomechanical evaluation of occipitocervicothoracic fusion: impact of partial or sequential fixation","volume":"8","author":"Cheng","year":"2008"},{"key":"b6-0080057","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"380","DOI":"10.3171\/2009.10.PEDS09296","article-title":"Equivalence of fusion rates after rigid internal fixation of the occiput to C-2 with or without C-1 instrumentation. Clinical article","volume":"5","author":"Hankinson","year":"2010"},{"key":"b7-0080057","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"529","DOI":"10.3171\/2009.2.PEDS08149","article-title":"Screw fixation of the upper cervical spine in the pediatric population. Clinical article","volume":"3","author":"Haque","year":"2009"},{"issue":"1 Suppl","key":"b8-0080057","series-title":"J Neurosurg","first-page":"81","article-title":"Occipitocervicothoracic fixation for spinal instability in patients with neoplastic processes","volume":"91","author":"Jackson","year":"1999"},{"key":"b9-0080057","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1097\/01.bpo.0000161091.85350.54","article-title":"Cervical kyphosis associated with anteroposterior dissociation and quadriparesis in Larsen's syndrome","volume":"25","author":"Katz","year":"2005"},{"key":"b10-0080057","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.1097\/00007632-200110150-00017","article-title":"Surgical treatment of congenital kyphosis","volume":"26","author":"Kim","year":"2001"},{"issue":"Suppl","key":"b11-0080057","series-title":"J Spinal Disord Tech","doi-asserted-by":"publisher","first-page":"S101","DOI":"10.1097\/01.bsd.0000127700.29969.e6","article-title":"Long-term results of occipitothoracic fusion surgery in RA patients with destruction of the cervical spine","volume":"18","author":"Matsuyama","year":"2005"},{"key":"b12-0080057","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1007\/s00381-009-0828-4","article-title":"Changes in cervical spine curvature in pediatric patients following occipitocervical fusion","volume":"25","author":"Moorthy","year":"2009"},{"key":"b13-0080057","series-title":"Spine (Phila Pa 1976)","doi-asserted-by":"publisher","first-page":"1336","DOI":"10.1097\/00007632-200206150-00017","article-title":"Evaluation of posterior long fusion versus conservative treatment for the progressive rheumatoid cervical spine","volume":"27","author":"Omura","year":"2002"},{"key":"b14-0080057","series-title":"J Pediatr Orthop","doi-asserted-by":"publisher","first-page":"762","DOI":"10.1097\/01241398-199711000-00011","article-title":"Increasing lordosis of the occipitocervical junction after arthrodesis in young children: the occipitocervical crankshaft phenomenon","volume":"17","author":"Rodgers","year":"1997"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/8\/1\/article-p57.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/8\/1\/article-p57.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/8\/1\/article-p57.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T15:50:31Z","timestamp":1681573831000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/8\/1\/article-p57.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2011,7]]},"references-count":14,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2011.4.peds10450","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2011,7]]}}}