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Use of a craniofacial miniplate for internal fixation in a young child with cervical instability. Case report
1Department of Neurosurgery, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, USA. neurosurgery@worldnet.att.net
Insights
A novel craniofacial miniplate technique offers a viable solution for anterior cervical fixation in young children, overcoming size limitations of standard devices. This method achieved solid fusion in a pediatric patient with severe cervical instability.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Biomedical Engineering
Background:
- Standard anterior cervical internal fixation devices are sized for adults and older children.
- Pediatric cervical vertebral bodies (VBs) are too small for conventional fixation systems.
- Severe cervical instability in young children presents unique surgical challenges.
Observation:
- A 2-year-old boy with a C3-4 complete ligamentous disruption and gross cervical instability underwent posterior and anterior surgical approaches.
- Conventional anterior cervical fixation devices were unsuitable due to size discrepancies between the VBs and the implants.
- A craniofacial miniplate was implanted anteriorly, supplemented with an external halo brace.
Findings:
- The craniofacial miniplate provided adequate stability for the interbody graft, facilitating successful spinal fusion.
- This modified approach allowed for anterior internal fixation in a patient where standard devices were not applicable.
- The patient achieved a solid fusion, indicating the efficacy of the miniplate technique.
Implications:
- This technique presents a reasonable alternative for anterior cervical fixation in pediatric patients with severe instability.
- It expands the options for surgical management of cervical spine injuries in very young children.
- Further research may validate this approach for broader application in pediatric spinal surgery.
Abstract:
Commercially available anterior cervical internal fixation devices are designed for placement in adults and older children. Use of these systems in preschool-aged children is precluded due to the small size of their cervical vertebral bodies (VBs). The authors describe a 2-year-old boy who suffered a C3-4 injury, resulting in complete ligamentous disruption. Because of the gross cervical instability, they elected to perform surgery via posterior and anterior approaches, supplemented with internal fixation, during the same operation. The purpose of the anterior internal fixation device is to deliver compressive forces onto the interbody graft and keep it in place, thus optimizing the potential for a successful fusion. Because of the discrepancy in size between the VBs and the plate and screws, however, the authors were unable to use any of the standard anterior cervical fixation devices. Instead, they implanted a craniofacial miniplate, and the patient was required to wear an external halo brace. The miniplate provided enough stability to allow for a solid fusion. The authors believe that this technique is a reasonable option in young children who require anterior cervical fixation.