C2 Translaminar Screw Fixation in Children

Yang, Brian; Glotzbecker, Michael P.; Troy, Michael; Proctor, Mark R.; Hresko, M. Timothy; Hedequist, Daniel

doi:10.1097/bpo.0000000000001176

Cited by 10 publications

(5 citation statements)

References 13 publications

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“…Pediatric cervical spine fusions may be indicated for a variety of traumatic, tumor, congenital or syndromic causes [1][2][3][4]. The small and often aberrant anatomy poses significant challenges in surgical management of these patients.…”

Section: Discussionmentioning

confidence: 99%

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Rate and risk factors for pediatric cervical spine fusion pseudarthrosis: opportunity for improvement

et al. 2023

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Purpose Although the pediatric population typically has a high union rate, the cervical spine has a reputation for frequent pseduarthrosis, as high as 38% in some prior series. Our purpose was to examine the rate and risk factors for pseudarthrosis in pediatric cervical spine fusions. Methods Retrospective review of all patients with ≥ 2 years follow-up undergoing cervical spinal fusion between January 2004 and December 2019 at a tertiary pediatric hospital. Pseudarthrosis was defined as an absence of radiographic union as assessed by the attending surgeon for which revision surgery was performed. Results 64 patients (mean age: 8.4 ± 4.7 years) met inclusion criteria. Mean follow-up was 63.3 ± 41.4 months (range: 24–187 months). 28 fusions (44%) included the occiput. 41 patients (64%) had instrumentation, while 23 patients (36%) had uninstrumented fusions. 48 (75%) patients had a halo for a mean of 97.6 ± 49.5 days. The incidence of pseudarthrosis was as follows: overall = 8/64 (12.5%); posterior fusion = 14.8% (8/54); anterior fusions = 0% (0/4); and anteroposterior fusions = 0% (0/6). The rate of pseudarthrosis was over 8 times higher in fusions involving the occiput (occipitocervical fusion: 25.0%; 7/28 vs. cervical alone: 2.8%; 1/36; p = 0.02). Although not statistically significant, the rate of pseudarthrosis was 3 times higher in uninstrumented fusions (21.7%; 5/23) than instrumented fusions (7.3%; 3/41) (p = 0.12). In patients with uninstrumented fusion to the occiput, pseudarthrosis rate was 35.7% (5/14), which was higher compared to those who did not (6.0%; 3/50) (p = 0.01). Incidence of pseudarthrosis was similar in patients who received autograft (13.0%; 7/54) compared to allograft alone (10.0%; 1/10) (p > 0.999). Conclusions The pseudarthrosis rate in pediatric cervical spine fusions remained high despite frequent use of halo immobilization and autograft. Patients with uninstrumented occipitocervical fusions are at particularly high risk with more than 1 in 3 developing a pseudarthrosis. Study design Retrospective, Comparative. Level of Evidence III.

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Section: Discussionmentioning

confidence: 99%

“…Pediatric cervical spine fusions are indicated for a variety of diagnoses and etiologies [1][2][3][4]. Although pediatric spine patients typically have high rates of union, the unique challenges of the pediatric cervical spine make it prone to pseudarthrosis, which has been as high as 38% in prior studies [5].…”

Section: Introductionmentioning

confidence: 99%

Rate and risk factors for pediatric cervical spine fusion pseudarthrosis: opportunity for improvement

et al. 2023

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“…This study found that fixation with C2 translaminar screws in 19 had a 100% initial fusion rate at 3 months post-op compared to 66.7% in 12 patients without translaminar screw fixation which was statistically significant [ 28 ]. The largest pediatric series to date with 39 C2 translaminar screws in 23 patients by Yang et al when examining all cervical constructs showed no screw-related complications, no neurological injuries, and all patients with clinical union [ 29 ]. The use of C2 translaminar screw in pediatric O-C fusion is proposed as the third option in the treatment paradigm proposed by Anderson et al if C1–C2 transarticular or pars screws are not appropriate, but there has been limited published clinical data [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

C2 translaminar screw fixation in pediatric occipitocervical fusion

Lee

et al. 2022

Childs Nerv Syst

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Purpose Rigid occipitocervical (O-C) instrumentation can reduce the anterior pathology and has a high fusion rate in children with craniovertebral instability. Typically, axis (C2) screw fixation utilizes C1–C2 transarticular screws or C2 pars screws. However, anatomic variation may preclude these screw types due to the size of fixation elements or by placing the vertebral artery at risk for injury. Pediatric C2 translaminar screw fixation has low risk of vertebral artery injury and may be used when the anatomy is otherwise unsuitable for C1–C2 transarticular screws or C2 pars screws. Methods We retrospectively reviewed a neurosurgical database at UCSF Benioff Children’s Hospital Oakland for patients who had undergone a cervical spinal fusion that utilized translaminar screws for occipitocervical instrumentation between 2002 and 2020. We then reviewed the operative records to determine the parameters of C2 screw fixations performed. Demographic and all other relevant clinical data were then recorded. Results Twenty-five patients ranging from 2 to 18 years of age underwent O-C fusion, with a total of 43 translaminar screws at C2 placed. Twenty-three patients were fused (92%) after initial surgery with a mean follow-up of 43 months. Two patients, both with Down syndrome, had a nonunion. Another 2 patients had a superficial wound dehiscence that required wound revision. One patient died of unknown cause 7 months after surgery. One patient developed an adjacent-level kyphosis. Conclusion When performing occipitocervical instrumentation in the pediatric population, C2 translaminar screw fixation is an effective option to other methods of C2 screw fixation dependent on anatomic feasibility.

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“…Previous research primarily focuses on morphometric measurements, including laminar length, thickness, angle, and height, for translaminar screw insertion on the axis and subaxial cervical segments for people without congenital cervical vertebral anomalies, indicating that TSP can be a reliable and alternative method at these levels. 8,[13][14][15][16][17] In addition, the acceptability of TSP is analyzed in some studies. Chan et al 18 performed morphometric analysis of the C1 and C2 laminae and found that 65.5% of C1 and 80.3% of C2 laminae could accept 3.5 mm screws.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the TSP is frequently utilized as a salvage method for C2 fixation in BI. Previous research primarily focuses on morphometric measurements, including laminar length, thickness, angle, and height, for translaminar screw insertion on the axis and subaxial cervical segments for people without congenital cervical vertebral anomalies, indicating that TSP can be a reliable and alternative method at these levels [ 8 , 13 - 17 ]. In addition, the acceptability of TSP is analyzed in some studies.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and Comparisons of Morphometric Measurements and Computed Tomography Hounsfield Unit Values of C2 Laminae for Translaminar Screw Placement Between Patients With and Without Basilar Invagination

et al. 2022

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Objective: Patients with basilar invagination (BI) had high incidences of vertebral variations and high-riding vertebral artery (HRVA) that might restrict the use of pedicle or pars screw and increase the use of translaminar screw on axis. Here, we conducted a radiographic study to investigate the feasibility of translaminar screws and the bone quality of C2 laminae in patients with BI, which were compared with those without BI as control to provide guidelines for safe placement.Methods: In this study, a total of 410 patients (205 consecutive patients with BI and 205 matched patients without BI) and 820 unilateral laminae of the axis were included at a 1:1 ratio. Comparisons with regard to insertion parameters (laminar length, thickness, angle, and height) for C2 translaminar screw placement and Hounsfield unit (HU) values for the assessment of the appropriate bone mineral density of C2 laminae between BI and control groups were performed. Besides, the subgroup analyses based on the Goel A and B classification of BI, HRVA, atlas occipitalization, and C2/3 assimilation were also carried out. Furthermore, the factors that might affect the insertion parameters and HU values were explored through multiple linear regression analyses.Results: The BI group showed a significantly smaller laminar length, thickness, height, and HU value than the control group, whereas no significant difference was observed regarding the laminar angle. By contrast, the control group showed significantly higher rates of acceptability for unilateral and bilateral translaminar screw fixations than the BI group. Subgroup analyses showed that the classification of Goel A and B, HRVA, atlas occipitalization, and C2/3 assimilation affected the insertion parameters except the HU values. Multiple linear regression indicated that the laminar length was significantly associated with the male gender (B = 0.190, p < 0.001), diagnoses of HRVA (B = -0.109, p < 0.001), Goel A (B = -0.167, p < 0.001), and C2/3 assimilation (B = -0.079, p = 0.029); the laminar thickness was significantly associated with the male gender (B = 0.353, p < 0.001), diagnoses of HRVA (B = -0.430, p < 0.001), Goel B (B = -0.249, p = 0.026), and distance from the top of odontoid to the Chamberlain line (B = -0.025, p = 0.003); laminar HU values were significantly associated with age (B = -2.517, p < 0.001), Goel A (B = -44.205, p < 0.001), Goel B (B = -25.704, p = 0.014), and laminar thickness (B = -11.706, p = 0.001).Conclusion: Patients with BI had narrower and smaller laminae with lower HU values and lower unilateral and bilateral acceptability for translaminar screws than patients without BI. Preoperative 3-dimensional computed tomography (CT) and CT angiography were needed for BI patients.

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C2 Translaminar Screw Fixation in Children

Abstract: Level IV-Case series.

Cited by 10 publications

References 13 publications

Rate and risk factors for pediatric cervical spine fusion pseudarthrosis: opportunity for improvement

Rate and risk factors for pediatric cervical spine fusion pseudarthrosis: opportunity for improvement

C2 translaminar screw fixation in pediatric occipitocervical fusion

Characteristics and Comparisons of Morphometric Measurements and Computed Tomography Hounsfield Unit Values of C2 Laminae for Translaminar Screw Placement Between Patients With and Without Basilar Invagination

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