Feasibility of Rigid Upper Cervical Instrumentation in Children

Geck, Matthew J.; Truumees, Eeric; Hawthorne, Dana; Singh, Devender; Stokes, John K.; Flynn, Amy

doi:10.1097/bsd.0b013e318291ce46

Cited by 34 publications

(30 citation statements)

References 16 publications

(21 reference statements)

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“…27,32 Rigid screw fixation provides superior mechanical stability and improved fusion rates compared with nonrigid techniques. 4,9,10,14,21 Rigid screw fixation often obviates the need for postoperative halo fixation. There are anatomical studies evaluating the feasibility of commercially available screws in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Kovanda¹,

Ansari²,

Qaiser³

et al. 2015

PED

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OBJECT Rigid screw fixation may be technically difficult in the upper cervical spine of young children. Intraoperative stereotactic navigation may potentially assist a surgeon in precise placement of screws in anatomically challenging locations. Navigation may also assist in defining abnormal anatomy. The object of this study was to evaluate the authors’ initial experience with the feasibility and accuracy of this technique, both for resection and for screw placement in the upper cervical spine in younger children. METHODS Eight consecutive pediatric patients 10 years of age or younger underwent upper cervical spine surgery aided by image-guided navigation. The demographic, surgical, and clinical data were recorded. Screw position was evaluated with either an intraoperative or immediately postoperative CT scan. RESULTS One patient underwent navigation purely for guidance of bony resection. A total of 14 navigated screws were placed in the other 7 patients, including 5 C-2 pedicle screws. All 14 screws were properly positioned, defined as the screw completely contained within the cortical bone in the expected trajectory. There were no immediate complications associated with navigation. CONCLUSIONS Image-guided navigation is feasible within the pediatric cervical spine and may be a useful surgical tool for placing screws in a patient with small, often difficult bony anatomy. The authors describe their experience with their first 8 pediatric patients who underwent navigation in cervical spine surgery. The authors highlight differences in technique compared with similar navigation in adults.

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Section: Discussionmentioning

confidence: 99%

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Kovanda¹,

Ansari²,

Qaiser³

et al. 2015

PED

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“…8). While clinical series suggest placement is feasible in most children, recent topographic studies suggest that in younger children there are significant anatomic constraints [6]. The present of anomalous vertebral arteries occur in up to 25% of patients, and although there is some biomechanical strength to unilateral transarticular screws, the rigidity of coupled C1 and C2 screw rod constructs is sufficient [1,17].…”

Section: Transarticular Screwsmentioning

confidence: 99%

“…Ultimately, almost all pediatric patients will have anatomy that will allow for placement of screws into C2. Geck, in his study of morphology in pediatric patients, showed that the vast majority of children were able to accept intralaminar screws even as young as 2 years of age [6]. There was more variability in the pedicle size in the patient population suggesting that intralaminar screws in young children remain a reasonable first option for screw placement.…”

Section: C2 Screw Fixationmentioning

confidence: 99%

“…Clinical success using lateral mass screws in adults has led multiple authors to complete reviews of computed tomography scan in children to define anatomical feasibility. Geck studied the lateral masses of fifty children ages two to six via computed tomography scan and found that the C1 lateral mass was a reliable structure with a width of 15 to 16 mm in children even as young as two [6]. Chamoun analyzed the lateral masses of 76 children via CT and defined the medial and superior inclination of screws as being possible in 151 of the 152 lateral masses identified [3].…”

Section: Fixation To the Atlasmentioning

confidence: 99%

“…The external occipital protuberance (EOP) and the associated midline occipital keel remain the thickest area of bone for screw fixation [5,8,24]. Geck recently completed a tomographic analysis of the occiput and cervical spine of 50 children ages two to six in order to define anatomical suitability for screw placement [6]. In that study, the mean thickness of the EOP varied from 8.6 to 10.3 mm and the midline occipital keel was able to accept screws in almost all cases.…”

Section: Occipital Fixationmentioning

confidence: 99%

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Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Hedequist

2014

HSS Jrnl

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Background: Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical techniques is paramount to surgical safety in pediatric patients. Questions/Purposes: This review article serves as an educational tool regarding the use of modern posterior instrumentation techniques for pediatric cervical deformity. Methods: Expert review based on clinical expertise and literature review. Results: The use of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine is discussed. Preoperative imaging requirements for pediatric patients undergoing cervical spine surgery are reviewed. Anatomy, morphologic studies, and surgical techniques are discussed for each area of instrumentation. Conclusions: Modern posterior cervical instrumentation techniques can be safely applied to the majority of pediatric patients who require an instrumented posterior cervical fusion. Patient safety revolves around thorough preoperative imaging tests, understanding of upper cervical anatomy, and meticulous surgical technique. Modern instrumentation leads to an improvement in fusion rates and a diminishment in immobilization requirements.

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Feasibility of 3.5 mm C2 pedicle screws in children: A computerized tomography analysis

Chen

Cen

et al. 2022

Clinical Anatomy

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There have been no studies with large sample sizes on growth of the pedicle of C2 in children. In the present study we measured the pedicle of C2 through computed tomography (CT) imaging in children aged less than 14 years and evaluated the suitability of the 3.5‐mm screw for the pedicle in such children. The study was conducted on CT morphometric images of 420 children in our hospital between June 2018 and June 2020. The width (D1), length (D2), height (D3), inclination angle (α), and tail angle (β) of the C2 pedicle were measured. One‐way analysis of variance and Student's t test were used for statistical analyses. The least‐square method was used to analyze the curve fitting the trend of anatomical change in the pedicle. The largest degree of goodness of fit determined the best‐fitting curve. The size of the pedicle of C2 increased with age. The median ranges of D1, D2, D3, α, and β were 3.312–5.431 mm, 11.732–23.645 mm, 3.597–8.038 mm, 32.583°–36.640°, and 24.867°–31.567°, respectively. The curves fitting the trends of D1 and D3 were power functions, whereas D2 was fitted by a logarithmic curve. However, no curve fitted α or β. A 3.5‐mm screw can be placed in the pedicle of C2 in children aged more than 1 year. The growth and development trend of this pedicle can provide an anatomical reference for deciding on posterior cervical surgery and for selecting and designing pedicle screws for children.

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Feasibility of Rigid Upper Cervical Instrumentation in Children

Cited by 34 publications

References 16 publications

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Feasibility of 3.5 mm C2 pedicle screws in children: A computerized tomography analysis

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