Translaminar screw fixation in the subaxial pediatric cervical spine

The use of spinal instrumentation to stabilize the occipitocervical junction in pediatric patients has increased and evolved in recent years. Wiring techniques have now given way to screw-rod or screw-plate techniques with or without postoperative external immobilization. Although C-2 translaminar screws have been used in these constructs, subaxial translaminar screws have not, to date, been described in either the pediatric or adult patient populations. The authors describe the feasibility of translaminar screw placement in the C-3 lamina. Rigid fixation with translaminar screws offers an alternative to subaxial fixation with lateral mass screws, allowing for formation of biomechanically sound spinal constructs and minimizing potential neurovascular morbidity. Their use requires careful analysis of preoperative imaging studies, intact posterior elements, and avoidance of violation of the inner laminar wall.