Pediatric atlantoaxial fixation with bilateral, crossing C-2 translaminar screws. Technical note

The authors describe the cases of three children in whom atlantoaxial instability was caused by os odontoideum, all requiring surgical fixation. Although C1-2 rod/cantilever constructs involving C-2 pedicle screws and C1-2 transarticular screws have been widely applied in adults, only C1-2 transarticular screw fixation has been reported in children. Both of these constructs potentially place the vertebral artery (VA) at risk because of the variable location of the transverse foramen. Atlantoaxial fixation with C-2 translaminar screws has recently been reported in adult cases in which the risk of VA injury was reduced. The authors report the successful results of rigid atlantoaxial fixation in three children in whom bilateral crossing C-2 translaminar screws were placed, and they discuss the possible advantages of this technique in the pediatric population.