{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T23:28:53Z","timestamp":1777591733981,"version":"3.51.4"},"reference-count":49,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,1]]},"abstract":"<jats:sec><jats:title>OBJECT<\/jats:title><jats:p>The long-term consequences of atlantoaxial (AA) and occipitocervical (OC) fusion and instrumentation in young children are unknown. Anecdotal reports have raised concerns regarding altered growth and alignment of the cervical spine after surgical intervention. The purpose of this study was to determine the long-term effects of these surgeries on the growth and alignment of the maturing spine.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A multiinstitutional retrospective chart review was conducted for patients less than or equal to 6 years of age who underwent OC or AA fusion with rigid instrumentation at 9 participating centers. All patients had at least 3 years of clinical and radiographic follow-up data and radiographically confirmed fusion. Preoperative, immediate postoperative, and most recent follow-up radiographs and\/or CT scans were evaluated to assess changes in spinal growth and alignment.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Forty children (9 who underwent AA fusion and 31 who underwent OC fusion) were included in the study (mean follow-up duration 56 months). The mean vertical growth over the fused levels in the AA fusion patients represented 30% of the growth of the cervical spine (range 10%\u201350%). Three different vertical growth patterns of the fusion construct developed among the 31 OC fusion patients during the follow-up period: 1) 16 patients had substantial growth (13%\u201346% of the total growth of the cervical spine); 2) 9 patients had no meaningful growth; and 3) 6 patients, most of whom presented with a distracted atlantooccipital dislocation, had a decrease in the height of the fused levels (range 7\u201323 mm). Regarding spinal alignment, 85% (34\/40) of the patients had good alignment at follow-up, with straight or mildly lordotic cervical curvatures. In 1 AA fusion patient (11%) and 5 OC fusion patients (16%), we observed new hyperlordosis (range 43\u00b0\u201362\u00b0). There were no cases of new kyphosis or swan-neck deformity, evidence of subaxial instability, or unintended subaxial fusion. No preoperative predictors of these growth patterns or alignment were evident.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>These results demonstrate that most young children undergoing AA and OC fusion with rigid internal fixation continue to have good cervical alignment and continued growth within the fused levels during a prolonged follow-up period. However, some variability in vertical growth and alignment exists, highlighting the need to continue close long-term follow-up.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2015.5.peds14728","type":"journal-article","created":{"date-parts":[[2015,10,9]],"date-time":"2015-10-09T13:58:17Z","timestamp":1444399097000},"page":"94-102","source":"Crossref","is-referenced-by-count":33,"title":["Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children"],"prefix":"10.3171","volume":"17","author":[{"given":"Benjamin C.","family":"Kennedy","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Randy S.","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brett E.","family":"Youngerman","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Columbia University, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M.","family":"McDowell","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Pittsburgh, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kristopher G.","family":"Hooten","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Florida, Gainesville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Couture","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew","family":"Jea","sequence":"additional","affiliation":[{"name":"Division of Pediatric Neurosurgery, Texas Children\u2019s Hospital, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Leonard","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Ohio State University, Columbus, Ohio;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sean M.","family":"Lew","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Medical College of Wisconsin\/Children\u2019s Hospital of Wisconsin, Milwaukee, Wisconsin;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David W.","family":"Pincus","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Florida, Gainesville, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Rodriguez","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, All Children\u2019s Hospital, St. Petersburg, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gerald F.","family":"Tuite","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, All Children\u2019s Hospital, St. Petersburg, Florida;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Diluna","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Yale University School of Medicine, New Haven, Connecticut; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas L.","family":"Brockmeyer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard C. 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