Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients

Richard C E Anderson, Brian T. Ragel, J. Mocco, Leif Erik Bohman, Douglas L. Brockmeyer

Research output: Contribution to journalArticle

90 Citations (Scopus)

Abstract

Object. Atlantoaxial and occipitocervical instability in children have traditionally been treated with posterior bone and wire fusion and external halo orthoses. Recently, successful outcomes have been achieved using rigid internal fixation, particularly C1-2 transarticular screws. The authors describe flow diagrams created to help clinicians determine which method of internal fixation to use in complex anatomical circumstances when bilateral transarticular screw placement is not possible. Methods. The records of children who underwent either atlantoaxial or occipitocervical fixation with rigid internal fixation over an 11-year period were retrospectively reviewed to define flow diagrams used to determine treatment protocols. Results. Among the 95 patients identified who underwent atlantoaxial or occipitocervical fixation, the craniocervical anatomy in 25 patients (six atlantoaxial and 19 occipitocervical fixations [26%]) required alternative methods of internal fixation. Types of screw fixation included loop or rod constructs anchored by combinations of C1-2 transarticular screws (15 constructs), C-1 lateral mass screws (11), C-2 pars screws (24), C-2 translaminar screws (one), and subaxial lateral mass screws (six). The mean age of the patients (15 boys and 10 girls) was 9.8 years (range 1.3-17 years). All 22 patients with greater than 3-month follow-up duration achieved solid bone fusion and maintained stable constructs on radiographic studies. Clinical improvement was seen in all patients who had preoperative symptoms. Conclusions. Novel flow diagrams are suggested to help guide selection of rigid internal fixation constructs when performing pediatric C1-2 and occipitocervical stabilizations. Use of these flow diagrams has led to successful fusion in 25 pediatric patients with difficult anatomy requiring less common constructs.

Original languageEnglish (US)
Pages (from-to)36-42
Number of pages7
JournalJournal of Neurosurgery
Volume107
Issue number1 SUPPL.
DOIs
StatePublished - Jul 2007
Externally publishedYes

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Pediatrics
Anatomy
Bone Wires
Orthotic Devices
Clinical Protocols
Bone and Bones

Keywords

  • Atlantoaxial stabilization
  • Craniovertebral junction
  • Occipitocervical stabilization
  • Pediatric neurosurgery
  • Rigid internal fixation

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neuroscience(all)

Cite this

Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. / Anderson, Richard C E; Ragel, Brian T.; Mocco, J.; Bohman, Leif Erik; Brockmeyer, Douglas L.

In: Journal of Neurosurgery, Vol. 107, No. 1 SUPPL., 07.2007, p. 36-42.

Research output: Contribution to journalArticle

Anderson, Richard C E ; Ragel, Brian T. ; Mocco, J. ; Bohman, Leif Erik ; Brockmeyer, Douglas L. / Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. In: Journal of Neurosurgery. 2007 ; Vol. 107, No. 1 SUPPL. pp. 36-42.
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abstract = "Object. Atlantoaxial and occipitocervical instability in children have traditionally been treated with posterior bone and wire fusion and external halo orthoses. Recently, successful outcomes have been achieved using rigid internal fixation, particularly C1-2 transarticular screws. The authors describe flow diagrams created to help clinicians determine which method of internal fixation to use in complex anatomical circumstances when bilateral transarticular screw placement is not possible. Methods. The records of children who underwent either atlantoaxial or occipitocervical fixation with rigid internal fixation over an 11-year period were retrospectively reviewed to define flow diagrams used to determine treatment protocols. Results. Among the 95 patients identified who underwent atlantoaxial or occipitocervical fixation, the craniocervical anatomy in 25 patients (six atlantoaxial and 19 occipitocervical fixations [26{\%}]) required alternative methods of internal fixation. Types of screw fixation included loop or rod constructs anchored by combinations of C1-2 transarticular screws (15 constructs), C-1 lateral mass screws (11), C-2 pars screws (24), C-2 translaminar screws (one), and subaxial lateral mass screws (six). The mean age of the patients (15 boys and 10 girls) was 9.8 years (range 1.3-17 years). All 22 patients with greater than 3-month follow-up duration achieved solid bone fusion and maintained stable constructs on radiographic studies. Clinical improvement was seen in all patients who had preoperative symptoms. Conclusions. Novel flow diagrams are suggested to help guide selection of rigid internal fixation constructs when performing pediatric C1-2 and occipitocervical stabilizations. Use of these flow diagrams has led to successful fusion in 25 pediatric patients with difficult anatomy requiring less common constructs.",
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