USE OF AXIAL AND SUBAXIAL TRANSLAMINAR SCREW FIXATION IN THE MANAGEMENT OF UPPER CERVICAL SPINAL INSTABILITY IN A SERIES OF 7 CHILDREN

• DOI: 10.1227/01.neu.0000338950.46195.9c
• Publication Date: 2009-05-21T21:30:09Z
• Authors: Roukoz B. Chamoun; Katherine M. Relyea; Keyne K. Johnson; William E. Whitehead; Daniel J. Curry; Thomas G. Luerssen; James M. Drake; Andrew Jea
• Keywords: Iliac crest

OBJECTIVE The management of upper cervical spinal instability in children continues to represent a technical challenge. Traditionally, number wiring techniques followed by halo orthosis have been applied; however, they associated with high rate nonunion and poor tolerance for the halo. Alternatively, C1–C2 transarticular screws C2 pars/pedicle allow more rigid fixation, but are technically demanding vertebral artery injuries. Recently, translaminar added armamentarium pediatric spine surgeon as simple biomechanically efficient method fixation. However, subaxial not described population. We describe our experience axial 7 patients. METHODS Seven patients diagnosis required surgical fixation (age, 19 months–14 years; sex, 4 boys 3 girls; follow-up, 4–21 months; etiology, trauma [3 patients], os odontoideum/os terminale [2 hypoplastic dens patients]). All underwent and/or screw insertion. Iliac crest bone graft was used fusion patients; morphogenic protein cancellous morselized allograft A collar applied 12 weeks postoperatively all cases. No intraoperative image guidance insertion screws. RESULTS had postoperative computed tomographic scan. Two placement bilateral crossing at C3 thoracic spine, respectively. Hybrid constructs (a combined pars screw) were incorporated found breach ventral laminar cortex. achieved solid fusion. One patient perioperative complication: prolonged dysphagia probably related C1 lateral mass rather than placement. CONCLUSION To knowledge, this report represents only series treated This shows that is viable option children. technique safe results adequate rates minimal complications.