{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T13:31:38Z","timestamp":1783776698304,"version":"3.55.0"},"reference-count":18,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The long-term effects of instrumentation and fusion of the occipital-cervical-thoracic spine on spinal growth in young children are poorly understood. To mitigate the effects of this surgery on the growing pediatric spine, the authors report a novel technique used in 4 children with severe cervical-thoracic instability. These patients underwent instrumentation from the occiput to the upper thoracic region for stabilization, but without bone graft at the craniovertebral junction (CVJ). Subsequent surgery was then performed to remove the occipital instrumentation, thereby allowing further growth and increased motion across the CVJ.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>Three very young children (15, 30, and 30 months old) underwent occipital to thoracic posterior segmental instrumentation due to cervical or upper thoracic dislocation, progressive kyphosis, and myelopathy. The fourth child (10 years old) underwent similar instrumentation for progressive cervical-thoracic scoliosis. Bone graft was placed at and distal to C-2 only. After follow-up CT scans demonstrated posterior arthrodesis without unintended fusion from the occiput to C-2, 3 patients underwent removal of the occipital instrumentation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Follow-up cervical spine flexion\/extension radiographs demonstrated partial restoration of motion at the CVJ. One patient has not had the occipital instrumentation removed yet, because only 4 months have elapsed since her operation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Temporary fixation to the occiput provides increased biomechanical stability for spinal stabilization in young children, without permanently eliminating motion and growth at the CVJ. This technique can be considered in children who require longer instrumentation constructs for temporary stabilization, but who only need fusion in more limited areas where spinal instability exists.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2017.7.focus17287","type":"journal-article","created":{"date-parts":[[2017,10,1]],"date-time":"2017-10-01T03:37:29Z","timestamp":1506829049000},"page":"E11","source":"Crossref","is-referenced-by-count":4,"title":["Temporary occipital fixation in young children with severe cervical-thoracic spinal deformity"],"prefix":"10.3171","volume":"43","author":[{"given":"Brian J.","family":"Kelley","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, Neurological Institute; and"},{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anas A.","family":"Minkara","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter D.","family":"Angevine","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Neurological Institute; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael G.","family":"Vitale","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence G.","family":"Lenke","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Columbia University Medical Center, NewYork-Presbyterian Morgan Stanley Children\u2019s Hospital, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard C. E.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Neurological Institute; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1 Suppl","key":"b1","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 RC","year":"2007","unstructured":"Anderson RC, Ragel BT, Mocco J, Bohman LE, Brockmeyer DL: Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg 107 (1 Suppl):36\u201342, 2007"},{"key":"b2","series-title":"J Bone Joint Surg Am","first-page":"399","article-title":"The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis","volume":"85-A","author":"Campbell RM Jr","year":"2003","unstructured":"Campbell RM Jr, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, : The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 85-A:399\u2013408, 2003"},{"key":"b3","series-title":"J Neurosurg Pediatr","first-page":"57","article-title":"Occipitocervicothoracic stabilization in pediatric patients","volume":"8","author":"Fargen KM","year":"2011","unstructured":"Fargen KM, Anderson RC, Harter DH, Angevine PD, Coon VC, Brockmeyer DL, : Occipitocervicothoracic stabilization in pediatric patients. J Neurosurg Pediatr 8:57\u201362, 2011"},{"key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"5","article-title":"Occipital screw pullout strength. A biomechanical investigation of occipital morphology","volume":"24","author":"Haher TR","year":"1999","unstructured":"Haher TR, Yeung AW, Caruso SA, Merola AA, Shin T, Zipnick RI, : Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976) 24:5\u20139, 1999"},{"key":"b5","series-title":"J Am Acad Orthop Surg","first-page":"370","article-title":"Cervical spine instrumentation in children","volume":"24","author":"Hedequist DJ","year":"2016","unstructured":"Hedequist DJ, Emans JB: Cervical spine instrumentation in children. J Am Acad Orthop Surg 24:370\u2013378, 2016"},{"key":"b6","series-title":"J Korean Neurosurg Soc","first-page":"347","article-title":"A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion","volume":"48","author":"Hyun SJ","year":"2010","unstructured":"Hyun SJ, Rhim SC, Kim YJ, Kim YB: A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion. J Korean Neurosurg Soc 48:347\u2013353, 2010"},{"key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"E313","article-title":"Temporary iliac fixation to salvage an acute L4 chance fracture following pedicle screw fixation for adolescent idiopathic scoliosis","volume":"42","author":"Kato S","year":"2017","unstructured":"Kato S, Lewis SJ: Temporary iliac fixation to salvage an acute L4 chance fracture following pedicle screw fixation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 42:E313\u2013E316, 2017"},{"key":"b8","series-title":"J Neurosurg Pediatr","first-page":"94","article-title":"Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children","volume":"17","author":"Kennedy BC","year":"2016","unstructured":"Kennedy BC, D\u2019Amico RS, Youngerman BE, McDowell MM, Hooten KG, Couture D, : Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children. J Neurosurg Pediatr 17:94\u2013102, 2016"},{"key":"b9","series-title":"J Pediatr Orthop","first-page":"260","article-title":"A classification of growth friendly spine implants","volume":"34","author":"Skaggs DL","year":"2014","unstructured":"Skaggs DL, Akbarnia BA, Flynn JM, Myung KS, Sponseller PD, Vitale MG: A classification of growth friendly spine implants. J Pediatr Orthop 34:260\u2013274, 2014"},{"issue":"1 Suppl","key":"b1","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 RC","year":"2007","unstructured":"Anderson RC, Ragel BT, Mocco J, Bohman LE, Brockmeyer DL: Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg 107 (1 Suppl):36\u201342, 2007"},{"key":"b2","series-title":"J Bone Joint Surg Am","first-page":"399","article-title":"The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis","volume":"85-A","author":"Campbell RM Jr","year":"2003","unstructured":"Campbell RM Jr, Smith MD, Mayes TC, Mangos JA, Willey-Courand DB, Kose N, : The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J Bone Joint Surg Am 85-A:399\u2013408, 2003"},{"key":"b3","series-title":"J Neurosurg Pediatr","first-page":"57","article-title":"Occipitocervicothoracic stabilization in pediatric patients","volume":"8","author":"Fargen KM","year":"2011","unstructured":"Fargen KM, Anderson RC, Harter DH, Angevine PD, Coon VC, Brockmeyer DL, : Occipitocervicothoracic stabilization in pediatric patients. J Neurosurg Pediatr 8:57\u201362, 2011"},{"key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"5","article-title":"Occipital screw pullout strength. A biomechanical investigation of occipital morphology","volume":"24","author":"Haher TR","year":"1999","unstructured":"Haher TR, Yeung AW, Caruso SA, Merola AA, Shin T, Zipnick RI, : Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine (Phila Pa 1976) 24:5\u20139, 1999"},{"key":"b5","series-title":"J Am Acad Orthop Surg","first-page":"370","article-title":"Cervical spine instrumentation in children","volume":"24","author":"Hedequist DJ","year":"2016","unstructured":"Hedequist DJ, Emans JB: Cervical spine instrumentation in children. J Am Acad Orthop Surg 24:370\u2013378, 2016"},{"key":"b6","series-title":"J Korean Neurosurg Soc","first-page":"347","article-title":"A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion","volume":"48","author":"Hyun SJ","year":"2010","unstructured":"Hyun SJ, Rhim SC, Kim YJ, Kim YB: A mid-term follow-up result of spinopelvic fixation using iliac screws for lumbosacral fusion. J Korean Neurosurg Soc 48:347\u2013353, 2010"},{"key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"E313","article-title":"Temporary iliac fixation to salvage an acute L4 chance fracture following pedicle screw fixation for adolescent idiopathic scoliosis","volume":"42","author":"Kato S","year":"2017","unstructured":"Kato S, Lewis SJ: Temporary iliac fixation to salvage an acute L4 chance fracture following pedicle screw fixation for adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 42:E313\u2013E316, 2017"},{"key":"b8","series-title":"J Neurosurg Pediatr","first-page":"94","article-title":"Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children","volume":"17","author":"Kennedy BC","year":"2016","unstructured":"Kennedy BC, D\u2019Amico RS, Youngerman BE, McDowell MM, Hooten KG, Couture D, : Long-term growth and alignment after occipitocervical and atlantoaxial fusion with rigid internal fixation in young children. J Neurosurg Pediatr 17:94\u2013102, 2016"},{"key":"b9","series-title":"J Pediatr Orthop","first-page":"260","article-title":"A classification of growth friendly spine implants","volume":"34","author":"Skaggs DL","year":"2014","unstructured":"Skaggs DL, Akbarnia BA, Flynn JM, Myung KS, Sponseller PD, Vitale MG: A classification of growth friendly spine implants. J Pediatr Orthop 34:260\u2013274, 2014"}],"container-title":["Neurosurgical Focus"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/43\/4\/article-pE11.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/43\/4\/article-pE11.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/neurosurg-focus\/43\/4\/article-pE11.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:05:49Z","timestamp":1779527149000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/neurosurg-focus\/43\/4\/article-pE11.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,10]]},"references-count":18,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2017.7.focus17287","relation":{},"ISSN":["1092-0684"],"issn-type":[{"value":"1092-0684","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,10]]}}}