title: Patient-reported outcomes of occipitocervical and atlantoaxial fusions in children.
abstract: OBJECTIVE There is limited literature on patient-reported outcomes (PROs) and health-related quality of life (HRQOL) outcomes in pediatric patients undergoing surgery for craniovertebral junction pathology. The aim of the present study was to assess surgical and quality of life outcomes in children who had undergone occipitocervical or atlantoaxial fusion. METHODS The authors retrospectively reviewed the demographics, procedural data, and outcomes of 77 consecutive pediatric patients who underwent posterior occipitocervical or atlantoaxial fusion between 2008 and 2015 at Texas Children's Hospital. Outcome measures (collected at last follow-up) included mortality, neurological improvement, complications, Scoliosis Research Society Outcomes Measure-22 (SRS-22) score, SF-36 score, Neck Disability Index (NDI), and Pediatric Quality of Life Inventory (PedsQL). Multivariate linear regression analysis was performed to identify factors affecting PROs and HRQOL scores at follow-up. RESULTS The average age in this series was 10.6 ± 4.5 years. The median follow-up was 13.9 months (range 0.5-121.5 months). Sixty-three patients (81.8%) were treated with occipitocervical fusion, and 14 patients (18.1%) were treated with atlantoaxial fusion. The American Spinal Injury Association (ASIA) grade at discharge was unchanged in 73 patients (94.8%). The average PRO metrics at the time of last follow-up were as follows: SRS-22 score, 4.2 ± 0.8; NDI, 3.0 ± 2.6; the parent's PedsQL (ParentPedsQL) score, 69.6 ± 22.7, and child's PedsQL score, 75.5 ± 18.7. Multivariate linear regression analysis revealed that older age at surgery was significantly associated with lower SRS-22 scores at follow-up (B = -0.06, p = 0.03), and the presence of comorbidities was associated with poorer ParentPedsQL scores at follow-up (B = -19.68, p = 0.03). CONCLUSIONS This study indicates that occipitocervical and atlantoaxial fusions in children preserve neurological function and are associated with acceptable PROs and ParentPedsQL scores, considering the serious nature and potential for morbidity in this patient population. However, longer follow-up and disease-specific scales are necessary to fully elucidate the impact of occipitocervical and atlantoaxial fusions on children.
authors: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
authors: Aditya
authors: A
authors: Vedantam
authors: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
authors: Daniel
authors: D
authors: Hansen
authors: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
authors: Valentina
authors: V
authors: Briceño
authors: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.
authors: Alison
authors: A
authors: Brayton
authors: Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and.|Section of Pediatric Neurosurgery, Riley Hospital for Children, Indiana University School of Medicine Department of Neurosurgery, Goodman Campbell Brain and Spine, Indianapolis, Indiana.
authors: Andrew
authors: A
authors: Jea
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000601:surgery*; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009777:Occipital Bone / Q000601:surgery*; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life / Q000523:psychology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000523:psychology / Q000639:trends*; D016896:Treatment Outcome
keywords: ASIA = American Spinal Injury Association; ChildPedsQL = child-reported PedsQL; HRQOL = health-related quality of life; IONM = intraoperative neuromonitoring; MCS = Mental Component Summary; NDI = Neck Disability Index; PCS = Physical Component Summary; PRO = patient-reported outcome; ParentPedsQL = parent-reported PedsQL; PedsQL = Pediatric Quality of Life Inventory; SRS-22 = Scoliosis Research Society Outcomes Measure–22; atlantoaxial fusion; health-related quality of life; occipitocervical fusion; patient-reported outcomes; pediatric neurosurgery; spine; surgical outcomes; traumatic atlantooccipital dislocation