A new posterior stabilization technique in pediatric subaxial cervical vertebrae: Stabilization of spinous processes with the microplate/screw system: A radiological anatomy study.

Abstract

There are limited options for posterior stabilization techniques in cases of cervical subaxial instability in children. We designed this study to investigate whether the spinous process (SP) stabilization, which was previously used in adults, can also be used in children. Children aged 4-12 years who were admitted to our hospital between 2012 and 2020 and underwent 3D cervical computed tomography (CT) were retrospectively screened. Children without cervical spine fractures, tumors, deformities, or any ab-normalities and motion artifacts on CT were included in the study. Eight hundred seventy children were identified. Then, 360 children randomly selected from the patient pool were divided into nine different age groups or 3 different age groups (4-6 years, 7-9 years, and 10-12 years). The length, height, thickness, and anomalies of subaxial SPs were studied on CT images of children. The suitability of the SPs for the microplate/screw stabilization system was investigated. The suitability rate for screw insertion was 57.6% and the suitability rate for the stabilization in at least one segmental unit was 74.7%. The eligibility rate for stabilization involving C3, 4, 5, 6, and 7 vertebrae was 16.1%. There were nine different stabilization combinations and C6-7 segmental unit (71.9%) were the most common in those combinations. Bifidity prevented screw insertion in 21% of children. We found that the screw acceptance rate of SP started to increase statistically around 8 years of age and the number of segmental units that could be stabilized was at the age of 10-12 at most. According to the results of this study, we believe that the SP stabilization method recommended for children can be used as a salvage method, to support anterior stabilization or alone in a small number of selected cases.