Anterior cervical fusion: Although no large series have been published regarding outcomes of anterior cervical fusion in children, anecdotal experience has shown that fusion rates are high and spinal alignment is not appreciably affected in most cases.
Posterior occipitocervical fusion: High fusion rates are expected for occipitocervical surgery with instrumentation. This has been shown in several small series of patients (2, 10). However, a recent report documents a 16% overall failure rate in occipitocervical fusions in a large population of patients (17). The most difficult population of patients in which to achieve fusion includes those with congenital anomalies and Down syndrome (23). Anderson et al. showed no evidence of cervical kyphotic or lordotic abnormalities in a series of 19 patients followed for an average of 2.5 years after occipitocervical arthrodesis (1). Furthermore, the study showed continued longitudinal growth through the fused segments, with 34% growth from occiput to C2 in unaffected children and 31% growth in the study population.
Posterior atlantoaxial fusion: Several studies have shown that instrumentation results in extremely high rates of fusion in those with atlantoaxial instability (9). Various methods of instrumentation have been used, all with equivalent results. This information is to be compared with older series, where bone and wire constructs augmented with a halo orthosis yielded an 84% fusion rate (15).