Screw fixation to C2 in children: a case series and technical report

Screw fixation into the axis (C2) provides a stable anchor for constructs encompassing the upper cervical spine or craniocervical spine. Screw fixation to C2 in the pediatric population is not well studied.

We reviewed the records of 17 pediatric patients who underwent surgical fixation to C2 for a variety of disorders. Operative reports, clinical charts, and computed tomography (CT) scans were reviewed to determine the presence of any intraoperative or postoperative screw-related complications.

The mean age of our patients was 10 years (range, 3-16 years). Preoperative CT scans revealed unfavorable anatomy for pars/transarticular screw placement in 1 patient caused by a high-riding vertebral artery on 1 side and in 1 patient because of a sclerotic pars. Intraoperative findings revealed 1 patient who was unable to have transarticular screws, they subsequently underwent pars screw placement at C2 and lateral mass screws at C1. There was 1 screw-related complication: 1 patient had an excessively long screw noted on routine postoperative CT scanning and had the screw replaced with a smaller screw through the same tract. There were no vertebral artery injuries and no neurological injuries. At a mean follow-up of 20 months (range, 13-36 months), all patients had obtained clinical union with no complications noted.

In our series, screw fixation to C2 was possible in all patients. There were no major complications, and all patients have clinically united. The C2 screw fixation should be considered in all patients with appropriate preoperative imaging and adhering to surgical dissection of the pars.