Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients

Douglas L. Brockmeyer, Walavan Sivakumar, Marcus D. Mazur, Christina Sayama, Hannah E. Goldstein, Sean M. Lew, Todd C. Hankinson, Richard C.E. Anderson, Andrew Jea, Philipp R. Aldana, Mark Proctor, Daniel Hedequist, Jay K. Riva-Cambrin

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Study Design. Multicenter retrospective cohort study with multivariate analysis. Objective. To determine factors predictive of posterior atlantoaxial fusion failure in pediatric patients. Summary of Background Data. Fusion rates for pediatric posterior atlantoaxial arthrodesis have been reported to be high in single-center studies; however, factors predictive of surgical non-union have not been identified by a multicenter study. Methods. Clinical and surgical details for all patients who underwent posterior atlantoaxial fusion at seven pediatric spine centers from 1995 to 2014 were retrospectively recorded. The primary outcome was surgical failure, defined as either instrumentation failure or fusion failure seen on either plain x-ray or computed tomography scan. Multiple logistic regression analysis was undertaken to identify clinical and technical factors predictive of surgical failure. Results. One hundred thirty-one patients met the inclusion criteria and were included in the analysis. Successful fusion was seen in 117 (89%) of the patients. Of the 14 (11%) patients with failed fusion, the cause was instrumentation failure in 3 patients (2%) and graft failure in 11 (8%). Multivariate analysis identified Down syndrome as the single factor predictive of fusion failure (odds ratio 14.6, 95% confidence interval [3.7-64.0]). Conclusion. This retrospective analysis of a multicenter cohort demonstrates that although posterior pediatric atlantoaxial fusion success rates are generally high, Down syndrome is a risk factor that significantly predicts the possibility of surgical failure. Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)754-760
Number of pages7
JournalSpine
Volume43
Issue number11
DOIs
StatePublished - Jun 1 2018

Fingerprint

Pediatrics
Down Syndrome
Multivariate Analysis
Arthrodesis
Multicenter Studies
Atlanto-Axial Fusion
Spine
Cohort Studies
Retrospective Studies
Logistic Models
Odds Ratio
Tomography
Regression Analysis
X-Rays
Confidence Intervals
Transplants

Keywords

  • atlantoaxial fusion
  • complications
  • craniovertebral junction
  • Down syndrome
  • instability
  • instrumentation
  • pediatric

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Brockmeyer, D. L., Sivakumar, W., Mazur, M. D., Sayama, C., Goldstein, H. E., Lew, S. M., ... Riva-Cambrin, J. K. (2018). Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients. Spine, 43(11), 754-760. https://doi.org/10.1097/BRS.0000000000002495

Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients. / Brockmeyer, Douglas L.; Sivakumar, Walavan; Mazur, Marcus D.; Sayama, Christina; Goldstein, Hannah E.; Lew, Sean M.; Hankinson, Todd C.; Anderson, Richard C.E.; Jea, Andrew; Aldana, Philipp R.; Proctor, Mark; Hedequist, Daniel; Riva-Cambrin, Jay K.

In: Spine, Vol. 43, No. 11, 01.06.2018, p. 754-760.

Research output: Contribution to journalArticle

Brockmeyer, DL, Sivakumar, W, Mazur, MD, Sayama, C, Goldstein, HE, Lew, SM, Hankinson, TC, Anderson, RCE, Jea, A, Aldana, PR, Proctor, M, Hedequist, D & Riva-Cambrin, JK 2018, 'Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients', Spine, vol. 43, no. 11, pp. 754-760. https://doi.org/10.1097/BRS.0000000000002495
Brockmeyer DL, Sivakumar W, Mazur MD, Sayama C, Goldstein HE, Lew SM et al. Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients. Spine. 2018 Jun 1;43(11):754-760. https://doi.org/10.1097/BRS.0000000000002495
Brockmeyer, Douglas L. ; Sivakumar, Walavan ; Mazur, Marcus D. ; Sayama, Christina ; Goldstein, Hannah E. ; Lew, Sean M. ; Hankinson, Todd C. ; Anderson, Richard C.E. ; Jea, Andrew ; Aldana, Philipp R. ; Proctor, Mark ; Hedequist, Daniel ; Riva-Cambrin, Jay K. / Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients. In: Spine. 2018 ; Vol. 43, No. 11. pp. 754-760.
@article{b376cd309ad94b91b7179ef785b43dd4,
title = "Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients",
abstract = "Study Design. Multicenter retrospective cohort study with multivariate analysis. Objective. To determine factors predictive of posterior atlantoaxial fusion failure in pediatric patients. Summary of Background Data. Fusion rates for pediatric posterior atlantoaxial arthrodesis have been reported to be high in single-center studies; however, factors predictive of surgical non-union have not been identified by a multicenter study. Methods. Clinical and surgical details for all patients who underwent posterior atlantoaxial fusion at seven pediatric spine centers from 1995 to 2014 were retrospectively recorded. The primary outcome was surgical failure, defined as either instrumentation failure or fusion failure seen on either plain x-ray or computed tomography scan. Multiple logistic regression analysis was undertaken to identify clinical and technical factors predictive of surgical failure. Results. One hundred thirty-one patients met the inclusion criteria and were included in the analysis. Successful fusion was seen in 117 (89{\%}) of the patients. Of the 14 (11{\%}) patients with failed fusion, the cause was instrumentation failure in 3 patients (2{\%}) and graft failure in 11 (8{\%}). Multivariate analysis identified Down syndrome as the single factor predictive of fusion failure (odds ratio 14.6, 95{\%} confidence interval [3.7-64.0]). Conclusion. This retrospective analysis of a multicenter cohort demonstrates that although posterior pediatric atlantoaxial fusion success rates are generally high, Down syndrome is a risk factor that significantly predicts the possibility of surgical failure. Level of Evidence: 3.",
keywords = "atlantoaxial fusion, complications, craniovertebral junction, Down syndrome, instability, instrumentation, pediatric",
author = "Brockmeyer, {Douglas L.} and Walavan Sivakumar and Mazur, {Marcus D.} and Christina Sayama and Goldstein, {Hannah E.} and Lew, {Sean M.} and Hankinson, {Todd C.} and Anderson, {Richard C.E.} and Andrew Jea and Aldana, {Philipp R.} and Mark Proctor and Daniel Hedequist and Riva-Cambrin, {Jay K.}",
year = "2018",
month = "6",
day = "1",
doi = "10.1097/BRS.0000000000002495",
language = "English (US)",
volume = "43",
pages = "754--760",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "11",

}

TY - JOUR

T1 - Identifying Factors Predictive of Atlantoaxial Fusion Failure in Pediatric Patients

AU - Brockmeyer, Douglas L.

AU - Sivakumar, Walavan

AU - Mazur, Marcus D.

AU - Sayama, Christina

AU - Goldstein, Hannah E.

AU - Lew, Sean M.

AU - Hankinson, Todd C.

AU - Anderson, Richard C.E.

AU - Jea, Andrew

AU - Aldana, Philipp R.

AU - Proctor, Mark

AU - Hedequist, Daniel

AU - Riva-Cambrin, Jay K.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - Study Design. Multicenter retrospective cohort study with multivariate analysis. Objective. To determine factors predictive of posterior atlantoaxial fusion failure in pediatric patients. Summary of Background Data. Fusion rates for pediatric posterior atlantoaxial arthrodesis have been reported to be high in single-center studies; however, factors predictive of surgical non-union have not been identified by a multicenter study. Methods. Clinical and surgical details for all patients who underwent posterior atlantoaxial fusion at seven pediatric spine centers from 1995 to 2014 were retrospectively recorded. The primary outcome was surgical failure, defined as either instrumentation failure or fusion failure seen on either plain x-ray or computed tomography scan. Multiple logistic regression analysis was undertaken to identify clinical and technical factors predictive of surgical failure. Results. One hundred thirty-one patients met the inclusion criteria and were included in the analysis. Successful fusion was seen in 117 (89%) of the patients. Of the 14 (11%) patients with failed fusion, the cause was instrumentation failure in 3 patients (2%) and graft failure in 11 (8%). Multivariate analysis identified Down syndrome as the single factor predictive of fusion failure (odds ratio 14.6, 95% confidence interval [3.7-64.0]). Conclusion. This retrospective analysis of a multicenter cohort demonstrates that although posterior pediatric atlantoaxial fusion success rates are generally high, Down syndrome is a risk factor that significantly predicts the possibility of surgical failure. Level of Evidence: 3.

AB - Study Design. Multicenter retrospective cohort study with multivariate analysis. Objective. To determine factors predictive of posterior atlantoaxial fusion failure in pediatric patients. Summary of Background Data. Fusion rates for pediatric posterior atlantoaxial arthrodesis have been reported to be high in single-center studies; however, factors predictive of surgical non-union have not been identified by a multicenter study. Methods. Clinical and surgical details for all patients who underwent posterior atlantoaxial fusion at seven pediatric spine centers from 1995 to 2014 were retrospectively recorded. The primary outcome was surgical failure, defined as either instrumentation failure or fusion failure seen on either plain x-ray or computed tomography scan. Multiple logistic regression analysis was undertaken to identify clinical and technical factors predictive of surgical failure. Results. One hundred thirty-one patients met the inclusion criteria and were included in the analysis. Successful fusion was seen in 117 (89%) of the patients. Of the 14 (11%) patients with failed fusion, the cause was instrumentation failure in 3 patients (2%) and graft failure in 11 (8%). Multivariate analysis identified Down syndrome as the single factor predictive of fusion failure (odds ratio 14.6, 95% confidence interval [3.7-64.0]). Conclusion. This retrospective analysis of a multicenter cohort demonstrates that although posterior pediatric atlantoaxial fusion success rates are generally high, Down syndrome is a risk factor that significantly predicts the possibility of surgical failure. Level of Evidence: 3.

KW - atlantoaxial fusion

KW - complications

KW - craniovertebral junction

KW - Down syndrome

KW - instability

KW - instrumentation

KW - pediatric

UR - http://www.scopus.com/inward/record.url?scp=85048080582&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85048080582&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000002495

DO - 10.1097/BRS.0000000000002495

M3 - Article

C2 - 29189644

AN - SCOPUS:85048080582

VL - 43

SP - 754

EP - 760

JO - Spine

JF - Spine

SN - 0362-2436

IS - 11

ER -