In-hospital and Long term outcomes after instrumentation in children aged 12 years or below with craniovertebral junction and cervical spine injury:10 years experience from a developing country

Introduction: We intend to present outcomes following instrumentation for craniovertebral junction(CVJ) and cervical spine trauma in young children.

Methods: Retrospective single centre chart review was conducted from January 2009-March 2024. Children with cervical spine and CVJ trauma aged 12 years or below who underwent instrumentation were included. Variables included- related to Demographics, injury, surgery, length of hospital stay, in-hospital mortality, status of urinary catheter at discharge and follow-up, survival, radiologic fusion at followup, presence of deformity at followup and functional outcome based on Modified Barthel Index(in children >4 years of age at followup). Long term outcomes were ascertained using telephonic interview.

Results: 32 children with mean[Standard Deviation(SD)]age at presentation of 8.2[3.04] years underwent instrumentation. 12(37.5%) had congential CVJ anomaly with superimposed trauma, 7(21.8%) had subaxial cervical injury(SACI), 6(18.75%) had odontoid fracture, 5(15.6%) had traumatic atlantoaxial dislocation(AAD) and 1(3.1%) case had combined CVJ trauma plus SACI and hangman fracture. At presentation 2(6.3%) children were American Spinal Injury Association (ASIA) Impairment Scale(AIS) A, 5(15.6%) were AIS B, 7(21.9%) were AIS E and 18(56.3%) were AIS D with mean(SD) ASIA motor score(AMS) of 71.8(21.3). Median[Interquartile Range(IQR)] Brain and Spinal Cord Injury Center(BASIC) score of cord injury on magnetic resonance imaging at presentation was 2[2]. Mean 2(6.25%) children underwent reoperations, 1(3.1%) child succumbed during hospital stay, 9(28.1%) were tracheostomized, 9(28.1%) children were discharged on in-dwelling catheters with 5(55.5%) of them being subsequently decatheterized at last followup and 2(22.2%) requiring clean intermittent catheterization, 28(90.3%) children survived till present with mean(SD) survival of 75.2(44.5) months with 26(92.8%) of them achieving radiological fusion at followup and 22/26(84.6%) achieving a good functional outcome(Modified Barthel Index≥12). There were no cases of progressive deformity at followup.

Conclusion : With current technology, instrumentation for CVJ and cervical trauma in very young children is feasible with good long term outcomes.