Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
HSS Journal ®
Published in: HSS Journal ® 1/2015

01-02-2015 | Cervical Spine Symposium

Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Review Article

Author: Daniel Hedequist, MD

Published in: HSS Journal ® | Issue 1/2015

Login to get access

Abstract

Background

Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical techniques is paramount to surgical safety in pediatric patients.

Questions/Purposes

This review article serves as an educational tool regarding the use of modern posterior instrumentation techniques for pediatric cervical deformity.

Methods

Expert review based on clinical expertise and literature review.

Results

The use of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine is discussed. Preoperative imaging requirements for pediatric patients undergoing cervical spine surgery are reviewed. Anatomy, morphologic studies, and surgical techniques are discussed for each area of instrumentation.

Conclusions

Modern posterior cervical instrumentation techniques can be safely applied to the majority of pediatric patients who require an instrumented posterior cervical fusion. Patient safety revolves around thorough preoperative imaging tests, understanding of upper cervical anatomy, and meticulous surgical technique. Modern instrumentation leads to an improvement in fusion rates and a diminishment in immobilization requirements.
Appendix
Available only for authorised users
Literature
1.
Anderson RC, Ragel BT, Mocco J, Bohman LE, Brockmeyer DL. Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg. 2007; 107: 36-42.PubMed
2.
Brockmeyer DL, York JE, Apfelbaum RI. Anatomical suitability of C1–2 transarticular screw placement in pediatric patients. J Neurosurg. 2000; 92: 7-11.CrossRefPubMed
3.
Chamoun RB, Whitehead WE, Curry DJ, Luerssen TG, Jea A. Computed tomography morphometric analysis for C-1 lateral mass screw placement in children. Clinical article. J Neurosurg Pediatr. 2009; 3: 20-23.CrossRefPubMed
4.
Desai R, Stevenson CB, Crawford AH, Durrani AA, Mangano FT. C-1 lateral mass screw fixation in children with atlantoaxial instability: case series and technical report. J Spinal Disord Tech. 2010; 23: 474-479.CrossRefPubMed
5.
Ebraheim NA, Lu J, Biyani A, Brown JA, Yeasting RA. An anatomic study of the thickness of the occipital bone. Implications for occipitocervical instrumentation. Spine. 1996; 21: 1725-1729. discussion 1729–1730.CrossRefPubMed
6.
Geck MJ, Truumees E, Hawthorne D, Singh D, Stokes JK, Flynn A. Feasibility of rigid upper cervical instrumentation in children: tomographic analysis of children aged 2 to 6. J Spinal Disord Tech. 2013.
7.
Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients. J Neurosurg Spine. 2005; 2: 164-169.CrossRefPubMed
8.
Haher TR, Yeung AW, Caruso SA, et al. Occipital screw pullout strength. A biomechanical investigation of occipital morphology. Spine. 1999; 24: 5-9.CrossRefPubMed
9.
Hankinson TC, Avellino AM, Harter D, et al. Equivalence of fusion rates after rigid internal fixation of the occiput to C-2 with or without C-1 instrumentation. J Neurosurg Pediatr. 2010; 5: 380-384.CrossRefPubMed
10.
Haque A, Price AV, Sklar FH, Swift DM, Weprin BE, Sacco DJ. Screw fixation of the upper cervical spine in the pediatric population. Clinical article. J Neurosurg Pediatr. 2009; 3: 529-533.CrossRefPubMed
11.
Harms J, Melcher RP. Posterior C1–C2 fusion with polyaxial screw and rod fixation. Spine. 2001; 26: 2467-2471.CrossRefPubMed
12.
Hedequist D, Proctor M. Screw fixation to C2 in children: a case series and technical report. J Pediatr Orthop. 2009; 29: 21-25.CrossRefPubMed
13.
Hedequist D, Hresko T, Proctor M. Modern cervical spine instrumentation in children. Spine. 2008; 33: 379-383.CrossRefPubMed
14.
Hedequist D, Bekelis K, Emans J, Proctor MR. Single stage reduction and stabilization of basilar invagination after failed prior fusion surgery in children with Down’s syndrome. Spine. 2010; 35: E128-E133.CrossRefPubMed
15.
16.
Jea A, Taylor MD, Dirks PB, Kulkarni AV, Rutka JT, Drake JM. Incorporation of C-1 lateral mass screws in occipitocervical and atlantoaxial fusions for children 8 years of age or younger. Technical note. J Neurosurg. 2007; 107: 178-183.CrossRefPubMed
17.
Lapsiwala SB, Anderson PA, Oza A, Resnick DK. Biomechanical comparison of four C1 to C2 rigid fixative techniques: anterior transarticular, posterior transarticular, C1 to C2 pedicle, and C1 to C2 intralaminar screws. Neurosurgery. 2006; 58: 516-521. discussion 516–521.CrossRefPubMed
18.
Lehman RA Jr, Dmitriev AE, Helgeson MD, Sasso RC, Kuklo TR, Riew KD. Salvage of C2 pedicle and pars screws using the intralaminar technique: a biomechanical analysis. Spine. 2008; 33: 960-965.CrossRefPubMed
19.
Melcher RP, Puttlitz CM, Kleinstueck FS, Lotz JC, Harms J, Bradford DS. Biomechanical testing of posterior atlantoaxial fixation techniques. Spine. 2002; 27: 2435-2440.CrossRefPubMed
20.
Patel AJ, Gressot LV, Boatey J, Hwang SW, Brayton A, Jea A. Routine sectioning of the C2 nerve root and ganglion for C1 lateral mass screw placement in children: surgical and functional outcomes. Childs Nerv Syst Off J Int Soc Pediatr Neurosurg. 2013; 29: 93-97.CrossRef
21.
Reilly CW, Choit RL. Transarticular screws in the management of C1–C2 instability in children. J Pediatr Orthop. 2006; 26: 582-588.CrossRefPubMed
22.
Steinmetz MP, Mroz TE, Benzel EC. Craniovertebral junction: biomechanical considerations. Neurosurgery. 2010; 66: 7-12.CrossRefPubMed
23.
Yeom JS, Buchowski JM, Park KW, Chang BS, Lee CK, Riew KD. Undetected vertebral artery groove and foramen violations during C1 lateral mass and C2 pedicle screw placement. Spine. 2008; 33: E942-E949.CrossRefPubMed
24.
Zipnick RI, Merola AA, Gorup J, et al. Occipital morphology. An anatomic guide to internal fixation. Spine. 1996; 21: 1719-1724. discussion 1729–1730.CrossRefPubMed
Metadata
Title
Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine
Review Article
Author
Daniel Hedequist, MD
Publication date
01-02-2015
Publisher
Springer US
Published in
HSS Journal ® / Issue 1/2015
Print ISSN: 1556-3316
Electronic ISSN: 1556-3324
DOI
https://doi.org/10.1007/s11420-014-9398-4

Other articles of this Issue 1/2015

HSS Journal ® 1/2015 Go to the issue

Cervical Spine Symposium

Anterior Surgical Treatment of Cervical Spondylotic Myelopathy

Case Report

Trunnion Corrosion as a Cause of Recurrent Pseudotumor

Original Article

Preoperative Predictors of Postoperative Opioid Usage, Pain Scores, and Referral to a Pain Management Service in Total Knee Arthroplasty

Surgical Technique

A Report on Three Consecutive Cases using Computer Tomography 3D Preoperative Planning for Conversion of Arthrodesed Hips to Total Hip Replacements

Case Report

Interdisciplinary Care Improves Functional Mobility in an Individual with Type IX Osteogenesis Imperfecta

Cervical Spine Symposium

Considerations for Prophylactic Surgery in Asymptomatic Severe Cervical Stenosis