title: Change in lordosis at the occipitocervical junction following posterior occipitocervical fusion in skeletally immature children.
abstract: METHODS
  Retrospective case series.
  
  
  OBJECTIVE
  Evaluate the change in lordosis at the occipitocervical junction occurring during growth in skeletally immature children treated with posterior occipitocervical arthrodesis versus patients skeletally mature at arthrodesis.
  
  
  BACKGROUND
  Posterior occipitocervical arthrodesis is often indicated for children who have instability of the upper cervical spine develop. Theoretically, in skeletally immature children, this approach retards the growth of the posterior spinal elements but allows the anterior spinal column to continue to grow with the risk of excessive lordosis of the cervical spine developing.
  
  
  METHODS
  There were 21 children, younger than 11 years (range 1.9-10.9) at surgery and expected to have normal spinal growth, followed radiographically for an average of 6.3 years (range 2.0-12.4). Postoperative lateral neutral radiographs were compared to those at most recent follow-up to measure the change in occipitocervical angle. These results were then compared to a series of control patients who were skeletally mature at surgery.
  
  
  RESULTS
  Average overall change in lordosis at the occipitocervical junction was -4.6 degrees (range -12.8 degrees to +6.5 degrees). Average annualized change was -0.28 degrees per vertebral level per year (range -1.13 degrees to +0.67 degrees). This annualized change in angle was statistically significant compared to the average change of +0.01 degrees (range -0.09 degrees to +0.11 degrees) measured in the control series of patients skeletally mature at surgery (P = 0.01).
  
  
  CONCLUSIONS
  Increasing lordosis occurs at the occipitocervical junction following fusion in skeletally immature children. If occipitocervical arthrodesis is indicated in a skeletally immature child, fusion in excessive extension and overtightening of posterior wires should be avoided.
authors.affiliation: Department of Orthopedics and Rehabilitation, University of Wisconsin, Madison, WI, USA.
authors.forename: Brian P D
authors.initials: BP
authors.lastname: Wills
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Auerbach
authors.forename: Michael P
authors.initials: MP
authors.lastname: Glotzbecker
authors.forename: Denis S
authors.initials: DS
authors.lastname: Drummond
authors.forename: John P
authors.initials: JP
authors.lastname: Dormans
mesh_terms: D001269:Atlanto-Occipital Joint / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007593:Joint Instability / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008141:Lordosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D009777:Occipital Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome