Cite

Copy

Tap on and choose 'Add to Home Screen' to create a shortcut app

Tap on and choose 'Add to Home Screen/Install App' to create a shortcut app

Tips for Managing Metabolic Bone Disorders in Children – Dominic Thompson, F.R.C.S. (SN)

This page was last updated on May 9th, 2017

  • Not all cases require surgery: The radiological findings in metabolic bone disorders must be interpreted in the context of the clinical progress of the child and the likely natural history of the underlying condition. Not all patients require surgical intervention but should remain under clinical and radiological surveillance.

Principles of Management

The principles of surgical management of cervical spine anomalies in metabolic bone disease can be summarized as follows:

  • Reduction of spinal deformity: Reduction of spinal deformity restores alignment.
  • Decompression of the neuraxis: Any compression of the brainstem or spinal cord by bone or ligamentous thickening needs to be addressed. The predominant direction of compression in relation to the neuraxis will indicate the surgical approach to achieve decompression. This might require anterior (transnasal or transoral), lateral (posterolateral, far lateral, extreme lateral) or posterior approaches.
  • Immobilization: Contemporary instrumentation techniques have a high rate of success in providing durable internal fixation.
  • Control of instability: In cases of severe instability or rapidly evolving neurological deficit, immobilization in a halo-body orthosis can improve symptoms and gain time to appropriately investigate and plan surgery.
  • Avoidance of extensive fusing: The extent of fixation should be sufficient to immobilize the affected spinal segment but not so long as to compromise residual motion.

Your donations keep us going

The ISPN Guide is free to use, but we rely on donations to fund our ongoing work and to maintain more than a thousand pages of information created to disseminate the most up-to-date knowledge in the field of paediatric neurosurgery.

By making a donation to The ISPN Guide you are also indirectly helping the many thousands of children around the world whose treatment depends on well-informed surgeons.

Please consider making a donation today.

Use the app

The ISPN Guide can be used as a standalone app, both on mobile devices and desktop computers. It’s quick and easy to use.

Fully featured

Free registration grants you full access to The Guide and host of featured designed to help further your own education.

Stay updated

The ISPN Guide continues to expand both in breadth and depth. Join our mailing list to stay up-to-date with our progress.