A Systematic Review of Post-Surgical Neck Rotation Status Following Atlantoaxial Arthrodesis in Pediatric Neurosurgical Patients

Introduction: Arthrodesis of the C1-C2 vertebral segment is a commonly used procedure in the treatment of atlantoaxial instability, although it can lead to postoperative neck range of motion (ROM) compromise. The aim of this study is to analyze the interplay between atlantoaxial fusion, preclinical characteristics, perioperative outcomes and postoperative ROM in pediatric patients.

Methods: A systematic review of the literature using PubMed, Google Scholar, and Web of Science electronic databases was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to explore post-surgical ROM following atlantoaxial fusion in pediatric patients.

Results: 34 articles met inclusion criteria including 26 case analyses and 8 retrospective studies. Of 159 total patients, 80 were males and presented with atlantoaxial instability (AAI)/subluxation (94) or atlantoaxial rotatory fixation (AARF) (57). Diagnosis was primarily via CT (145 patients) and MRI (100). Patients with AAI (62% vs 36%, p< 0.001) had higher rates of improved post-surgical neck rotation as compared to patients with AARF. Furthermore, patients presenting with neck pain (94% vs 6%, p< 0.001) and torticollis (65% vs 35%, p< 0.05) prior to surgery had higher rates of decreased post-surgical neck rotation. Notably, patients that underwent surgical fusion of the atlantoaxial joint (77% vs 23%, p< 0.001) had higher rates of return to normal neck rotation at last follow. Patients that received conservative treatment prior to surgical fusion (91% vs 9%, p< 0.001) had higher rates of decreased post-surgical neck rotation whereas patients that underwent surgical fusion prior to conservative treatment (70% vs 30%, p< 0.001) had higher rates of return to normal post-surgical neck rotation.

Conclusion : Although limitations in post-surgical neck ROM are a common concern following atlantoaxial fusion, our study found that most pediatric patients experience return to normal post-surgical neck ROM following the procedure.