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Pediatric atlantoaxial instability: management with screw fixation
1Division of Neurosurgery, Ohio State University, and Columbus Children's Hospital, Columbus, Ohio, USA. jinwang@postbox.acs.ohio-state.edu
Pediatric Neurosurgery
|May 15, 1999
Summary
Pediatric atlantoaxial instability can be safely treated with screw fixation. Odontoid screws are effective for type II odontoid fractures in children over 3, while posterior C1-2 fixation suits those over 4.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Spinal Surgery
Background:
- Atlantoaxial instability (AAI) in children presents unique challenges for surgical management.
- Screw fixation techniques offer potential for stable fusion in pediatric AAI cases.
Observation:
- Sixteen pediatric patients (3-15 years) with AAI underwent either odontoid screw fixation (n=3) or posterior C1-2 transarticular screw fixation with Sonntag C1-2 fusion (n=13).
- Indications included type II odontoid fractures, os odontoideum, congenital AAI, and traumatic C1-2 instability.
- Postoperative management involved Miami-J collars, with all patients achieving fusion by 3 months.
Findings:
- Odontoid screw fixation demonstrated clear bony fusion for type II odontoid fractures (fracture age <4 weeks, intact transverse ligament).
- Posterior C1-2 transarticular screw fixation achieved high fusion rates in children over 4 years.
- Complications were minimal, including transient dysphagia and one instance of fusion extending to C2-3.
Implications:
- Odontoid screw fixation is a safe and effective option for select pediatric type II odontoid fractures.
- Posterior C1-2 transarticular screw fixation provides a reliable fusion method for older children with AAI.
- These findings support the use of screw fixation techniques in pediatric spinal surgery for AAI.