Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients

Anderson, Richard C. E.; Ragel, Brian T.; Mocco, J; Bohman, Leif‐Erik; Brockmeyer, Douglas L.

doi:10.3171/ped-07/07/036

Cited by 76 publications

(86 citation statements)

References 30 publications

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“…C1-2 transarticular screws have been shown to be very effective at providing a solid fusion construct in pediatric patients with atlantoaxial instability [1,2,6,18]. While transarticular screws can be safe and effective choice, their placement is technically demanding and in some patients, there are some potential advantages to the use of a GoelHarms construct.…”

Section: Discussionmentioning

confidence: 99%

“…In most studies on C1-2 fusion autograft was taken from the hip or rib [1,2,5,7,8,13,18,20,23,25]. Goel-Harms constructs do not require a structural graft so hip graft may not be needed.…”

Section: Discussionmentioning

confidence: 99%

“…Traditional posterior wiring techniques, including Brooks and Gallie fusions, have a long history of success in all age groups [7,8,16,29]. More recently, the introduction of transarticular C1-2 fusions have been described and when technically possible have been shown to be effective in adults as well as pediatric patients [1,2,6,13,18,19,39]. …”

Section: Introductionmentioning

confidence: 99%

“…The Goel-Harms construct consists of placement of screws into the lateral mass of C1 coupled to C2 pedicle screws. Additionally, a modification of the traditional Goel-Harms construct was been described that uses C2 trans-laminar screws [2,28]. These techniques have a high rate of fusion and can limit some of the potential morbidity associated with other techniques.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

et al. 2009

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There are several treatment options for rigid fixation at C1-C2 including Brooks and Gallie type wired fusions and C1-2 transarticular screws. The use of a GoelHarms type fusion, a construct with C1 lateral mass screws and C2 pedicle screws, has not been extensively described in pediatric patients. Here, we describe its relatively safe and effective use for treating pediatric patients by retrospective chart review of patients treated by the senior author for atlantoaxial instability with a Goel-Harms-type constructs during a 3-year period (2005)(2006)(2007). Six patients were treated using Goel-Harms-type constructs. Five patients were treated utilizing a construct containing C1 lateral mass screws and C2 pedicle screws; one patient was treated using construct containing C1 lateral mass screws and C2 trans-laminar screws. The patients ranged in age from 7 to 17 years old (mean 12.7). All patients had findings of an os odontoideum on CT scans and three of the six patients had T2 hyperintensity on MRI. Three of the six patients presented with transient neurologic deficits: quadraplegia in two patients and paresthesias in two patients. In each patient C1 lateral mass and C2 screws were placed and the subluxation was reduced to attain an anatomical alignment. No bone grafts were harvested from the iliac crest or rib. Local morsalized bone and sub-occipital skull graft was used. All patients tolerated the procedure well and were discharged home on post-operative day 3-4. The patients wore a hard cervical collar and no halo-vests were needed. All patients had solid fusion constructs and normal alignment on post-operative imaging studies performed on average 14 months post-operatively (range: 7-29). The results demonstrated that Goel-Harms fusions are a relatively safe and effective method of treating pediatric patients with atlantoaxial instability and are not dependent on vertebral anatomy or an intact ring of C1. Follow-up visits and studies in this limited series of patients demonstrated solid fusion constructs and anatomical alignment in all patients treated.

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Section: Discussionmentioning

confidence: 99%

“…In most studies on C1-2 fusion autograft was taken from the hip or rib [1,2,5,7,8,13,18,20,23,25]. Goel-Harms constructs do not require a structural graft so hip graft may not be needed.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

et al. 2009

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“…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]. We have used transarticular screws for pediatric cervical fusions and published these results; however, we have favored more recent placement of C1 lateral mass screws with appropriate C2 screws [12].…”

Section: Transarticular Screwsmentioning

confidence: 99%

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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Nosographic Identification and Management of Pediatric Craniovertebral Junction Anomalies: Evolution of Concepts and Modalities of Treatment

Menezes

2013

Advances and Technical Standards in Neurosurgery

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The clinical significance of abnormalities of the craniocervical junction has gained tremendous momentum with the increasing interest in the area as a result of better neurodiagnostic imaging. Abnormalities of the bone, soft tissue, and neural structures are easily recognized and there is a better understanding of the biomechanics of this complex region as well as the embryology. A database of symptomatic patients, children, and adults with neurological symptoms and signs secondary to abnormalities at the craniocervical junction have been evaluated by the author at the University of Iowa Hospitals and Clinics. This large database comprises 6,000 patients and provides a better awareness of the natural history of abnormalities as well as diseases affecting this area.A surgical physiological approach to pathology at this region was proposed in 1977 and still holds true. However, with the advent of better imaging as well as surgical approaches and instrumentation, treatment of problems in this region can be divided into the clinical syndromes, surgical approaches, and techniques of stabilization. A brief outline of the evolving nature of this is provided in this manuscript.

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Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients

Cited by 76 publications

References 30 publications

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

Treatment of pediatric atlantoaxial instability with traditional and modified Goel–Harms fusion constructs

Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

Nosographic Identification and Management of Pediatric Craniovertebral Junction Anomalies: Evolution of Concepts and Modalities of Treatment

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