Lateral mass screw fixation in children

Daniel Hedequist,Mark Proctor,Timothy Hresko

doi:10.1007/s11832-010-0251-0

Daniel Hedequist, Mark Proctor + Show 1 more

Open Access

https://doi.org/10.1007/s11832-010-0251-0

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Abstract

The safety and feasibility of posterior screw fixation of the cervical spine in children has not been well documented in the orthopedic literature. We performed a retrospective review of our experience using posterior cervical screw fixation in children. The medical records and radiologic records of 36 children at a mean age of 10years (range 3-16 years) were reviewed. Diagnoses included: ten instability, 11 deformity, seven trauma, five tumor, and three congenital abnormalities. Operative reports and postoperative computed tomography (CT) scans were reviewed to determine the technical feasibility of screw placement, any screw-related complications, and to assess for correct screw position. In this series, there were no neurologic complications, no vertebral artery injuries, and no screw-related complications. Thirty patients (141 screws) had screws evaluated postoperatively and were shown to be completely contained on postoperative CT scans. There were no revisions due to screw failure or dislodgement. There were no vascular or neurologic complications. Posterior screw fixation in the pediatric population may be done safely and greatly enhances fixation strength for a variety of disorders requiring instrumentation and fusion.

Highlights

The ability to obtain solid internal fixation for cervical spinal disorders enhances fusion rates and reduces the need for postoperative halo application with its potentially untoward consequences
Purpose The safety and feasibility of posterior screw fixation of the cervical spine in children has not been well documented in the orthopedic literature
A retrospective analysis of preoperative computed tomography (CT) scans in these patients revealed no clear reason for the inability to obtain purchase at the stated levels

Summary

Introduction

The ability to obtain solid internal fixation for cervical spinal disorders enhances fusion rates and reduces the need for postoperative halo application with its potentially untoward consequences. Lateral mass fixation of the cervical spine has been popularized by Roy-Camille and others as a safe and efficacious method of obtaining solid cervical fixation [1]. Rigid fixation of the pediatric spine enhances the ability to obtain a fusion and diminishes the need and/or length of postoperative immobilization. Previous reports on cervical fixation in children have focused on non-rigid techniques such as wire-rod configurations. The earliest reports on rigid fixation in children included the description of transarticular screws in cases of upper cervical spine instability [6].

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