| Background and purposeThe craniocervical junction region(CVJ)has many anatomical variants and complex structures,often combined with anomalies of the vertebral artery,making surgery in this region technically demanding and risky.In pediatric patients with CVJ disease mostly involving atlantoaxial instability and anatomical variants such as occipitocervical fusion and Basilar invagination,most patients can be treated by posterior surgery.However,as the volume of surgery increases,surgical failure cannot be ignored,and the causes of surgical failure,fusion rate of bone graft,differences in different bone graft materials,and strategies for revision surgery have not been clarified.The objectives of the study were:(ⅰ)to analyze the causes of failure of posterior CVJ surgery in pediatric patients;(ⅱ)to investigate the factors affecting the fusion rate of implants in posterior CVJ surgery in pediatric patients,and to analyze the effects of different bone graft materials on the fusion rate of implants and surgical complications in posterior CVJ surgery;and(ⅲ)to develop revision strategies for pediatric CVJ patients with initial surgical failure to provide reference for surgeons and improve surgical outcomes.Materials and MethodsTo retrospectively analyze the clinical data of pediatric patients who underwent posterior CVJ surgery in our department from January 2006 to December 2022.1.To screen patients who underwent revision surgery for initial surgical failure and to analyze the reasons for this.2.To analyze the risk factors associated with bone graft fusion and the differences in the use of different bone graft materials(autologous rib,autologous iliac bone,and allograft bone)in posterior CVJ fusion surgery in pediatric patients.3.To collect cases undergoing revision surgery,record perioperative Japanese Orthopaedic Association(VAS)score and Visual Analogue Scale(JOA)score,Cervicomedullary angle(CMA),etc.to assess the results of revision and to summarize the development of revision strategies.Results1.9 cases of postoperative revision surgery were completed in our hospital,and the revision rate was 6.72%.The main causes of revision were failure of internal fixation and non-fusion of bone graft.2.In pediatric patients undergoing posterior fixation surgery for CVJ,the common reasons affecting bone fusion rate are the choice of bone graft material and infectious complications.When different bone graft materials were used for posterior CVJ surgery in pediatric patients,the 3-month bone graft fusion rates were 94.2%,90.1%,and 42.9%for autologous ribs,autologous iliac bone,and allograft bone,respectively.The complication rate of the iliac bone was 5.83%,and no complications in the bone extraction area were observed in patients with rib implants.3.Postoperative bony fusion was obtained in all patients with revision surgery,and the mean JOA score and neck pain VAS score at the final follow-up were significantly improved compared with the preoperative scores.Conclusion1.The overall revision rate of posterior CVJ fusion fixation surgery in pediatric patients at our institution was 6.72%,and the most common causes were failure of internal fixation and non-fusion of bone graft.2.In this study,we investigated the factors influencing the rate of implant fusion in patients undergoing posterior CVJ internal fixation surgery in pediatric patients,and the common risk factor was the choice of implant material and complication of infection.When different bone graft materials(autologous rib,autologous iliac bone,and allograft bone)were used in posterior CVJ fusion surgery in pediatric patients,the short-term fusion rate was higher for autologous iliac bone and autologous rib bone than for allograft bone.Donor site complications were less when autologous rib bone graft was used.Autologous rib can be used as the preferred source of bone graft for the posterior fixation fusion surgery of the craniocervical junction area in pediatric patients.3.A revision strategy was developed for patients with failed posterior CVJ surgery. |
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