Follow-up for Metabolic Bone Disease in Children

Frequency of Office Visits

• Wound check within 2 weeks of surgery: At discharge arrangements should be made for wound review within 2 weeks.
• 4-6 weeks for first follow-up: The child is seen for outpatient follow-up or within 4-6 weeks of surgery.
• Pin site checks for halo orthotics: If a halo-body orthosis has been applied, the child is reviewed at 2-week intervals to evaluate pin sites and to ensure that mechanical fittings are appropriately secure.
• Multidisciplinary follow-up: Even after successful neurosurgical interventions children with metabolic bone disease require lifelong multidisciplinary follow-up. They remain at risk of disease at other sites along the spine.
• Community follow up: Children with metabolic bone disease will frequently have significant physical disabilities and local input from general pediatrician, physical therapist, occupational therapist is important to ensure that their specific needs are met in the home and at school.

Frequency of Imaging

• Comparative plain x-rays to confirm maintenance of alignment: Plain x-rays are ordered after surgery. The frequency of imaging will vary according to circumstance. However, the main objectives of follow-up imaging are to ensure that alignment is maintained and, ultimately, rigid fixation is achieved.
• Flexion-extension x-rays once bone fused: Once bony fusion is thought to have been established (usually 2–3 months after surgery), dynamic imaging (flexion and extension cervical spine x-rays should be obtained for confirmation.   
• MRI to document decompression: If decompressive procedures were required because of compression of the neuraxis, MRI is indicated to ascertain the effectiveness of surgery and as a baseline for future follow-up.
• Radiological surveillance: There are no accepted guidelines for follow-up imaging. However, given the rarity and complexity of these conditions, most surgeons recommend surveillance imaging on an annual basis . Additionally, in young children clinical assessment can be difficult, and disease progression in the spine can occur in the absence of clinical signs. In a child who is clinically stable, annual MRI of the spine is sufficient.

Other Investigations Required