Jonathan H Philllips MD Orlando Florida USA Rigid stabilization of cervical spine lesions in neurologically symptomatic paediatric patients does not improve recovery in comparison with older non rigid techniques. Jonathan H Philllips MD Orlando Florida USA

Hypothesis Rigid fixation will improve neurological recovery in impaired paediatric patients with c-spine pathology.

Methods Retrospective medical record review was performed of children’s cervical spinal surgery over 17 years. Patients with preoperative neurological findings were identified.

Methods Separation of two groups based on rigid or non-rigid fixation was made. Rigid fixation was defined as bone screws and rods, non-rigid was defined as wire fixation with halo immobilization. Neurological recovery was assessed in the two groups.

Non Rigid: wires and halo at C1/2

Rigid: screws and rods at O/C1/C2

Results 52 patients underwent surgical fusion for various diagnoses including traumatic syndromic and dysplastic conditions. 17 of these patients were identified with preexisting neurological lesions varying from complete quadriplegia to mild ataxia and hyperreflexia. Follow up average 33.5 months with a range from 7 – 80 months

Results 4 historically earlier patients underwent non-rigid wiring techniques with halo or other external stabilization. All recovered neurologically to a greater or lesser extent. None worsened neurologically.

Results 13 patients underwent rigid rod and screw fixation. 10 patients recovered, three did not. In this group one patient who deteriorated after the initial surgery revision after which recovery ensued. All the patients who showed no recovery had complete spinal cord lesions and were quadriplegic at presentation

Discussion Study limitations: retrospective, small numbers of patients particularly the non rigid group Not controlled for severity of neuro loss Study strengths: long term series (17 years) allowing for capture of ‘older’ techniques not now commonly used

Summary Modern rigid techniques of cervical fixation have not been mirrored, in our institution, with noticeable improvements in neurological outcomes. Factors other than surgical technique are important in recovery from neurological loss in children’s cervical spine conditions.

Conclusion Rigid stabilization of cervical spine lesions in neurologically symptomatic patients does not improve recovery in comparison with older techniques.