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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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Pediatric cervical sagital deformity – a 6 case series

Andreia Mercier Nunes1, Pedro Jordão2, Jorge Mineiro2, João Lameiras Campagnolo2

1 - Serviço de Ortopedia do Hospital de São Francisco Xavier – CLHO – Lisboa
2 - Serviço de Ortopedia Pediátrica, Hospital Dona Estefânia – Centro Hospitalar Universitário de Lisboa Central, Lisboa

ICEOS 2018 – Lisboa 12-11-2018 (Comunicação Livre – Congresso Internacional)

Resumo: Paediatric cervical sagittal abnormalities are rarely found. We relate a series of 6 cases of sagittal cervical deformity, where sagittal balance had to be surgically restored. We report a 6 case series with multiple etiologies: congenital, infectious, traumatic, CNS malformations. 2 cases needed 2-stage surgery and 4 cases a single stage/single approach surgery was performed (2 posterior and 2 anterior). We report one uneventful complication. Sagittal balance should be kept in mind to achieve a good short and long-term result.
Hypothesis: Sagittal balance is essential for a good result.
Methods: 6 patients surgically treated, for a 9-year period. The mean age was 10,5 year-old (3- 16). Regarding the diagnosis our series presented: post-traumatic C1-C2 dislocations in 21 trisomy patients (2 cases), kyphosis post-occipito-cervical laminectomy in an Arnold-Chiari type 1 (1 case), cervical tuberculosis sequelae (2 cases), and a cervical hemivertebra (1 case). In 2 cases, there was need for 2-stage surgery (double posterior approach and posterior and anterior approach). In the other 4 cases a single stage/single approach surgery was performed (2 posterior and 2 anterior).
Results: We report one uneventful complication: a C1 screw malpositioning that needed revision surgery. The evolution was favourable in all cases. Normal neurological patients didn’t suffer any complication, and those who had prior neurological deficit recovered significantly. Cervical sagittal balance was restored in all cases. The treatment of these patients requires detailed planning, experience and surgical skills. The authors believe that this case series illustrates some of the treatment options available.
Conclusion: Cervical spine deformities in a growing skeleton are rare and can be very challenging to treat. Sagittal balance should be kept in mind to achieve a good short and long-term result.

Palavras Chave: equilíbrio, cervical, coluna, pediátrico, sagital