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Updated: Jun 23, 2026
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C-arm-Free Simultaneous OLIF51 and Percutaneous Pedicle Screw Fixation in a Single Lateral Position
Published on: September 16, 2022
Cervical fixation in the pediatric patient: our experience
Marco Crostelli1, Massimo Mariani, Osvaldo Mazza
1Vertebral Disease Operative Unit, Pediatric Surgery Department, Bambino Gesù Pediatric Hospital, Palidoro, Rome, Italy. crostelli@opbg.net
Summary
Pediatric cervical spine fusion can be safely performed in younger children using adapted instrumentation. This study shows that anatomical size, not age, is key for successful surgical management of cervical instability in children.
Area of Science:
- Pediatric Orthopedics
- Spine Surgery
- Cervical Spine Instability
Background:
- Cervical instability in children presents unique surgical challenges due to anatomical size and tissue biology.
- Indications for internal fixation are similar to adults, but require precise pre-operative assessment and surgical technique.
- A wide spectrum of conditions necessitates cervical fusion in pediatric patients.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical management for cervical instability in pediatric patients.
- To assess the feasibility of using adapted instrumentation in younger children.
- To determine the primary factors influencing the choice of surgical technique for pediatric cervical fusion.
Main Methods:
- Retrospective case study of 31 pediatric patients (average age 7 years 6 months) undergoing cervical fusion.
- Analysis of various pathologies including congenital deformities, systemic diseases, tumors, and trauma.
- Application of occipito-cervical fusion (11 cases) and instrumentation (13 cases), including rigid adult instrumentation and sublaminar wiring.
- Radiological assessment (X-ray, CT, MRI) for fusion and complications.
Main Results:
- Two cases of sublaminar wiring rupture occurred without affecting bone fusion.
- No major complications such as infection, instrumentation failure, neurological impairment, or significant loss of motion were observed.
- Successful cervical fusion was achieved in all patients, with effective management of instability.
- Rigid adult instrumentation was used in children under 10, and wiring in those under 36 months, challenging age-based guidelines.
Conclusions:
- Surgical management of pediatric cervical instability is feasible and safe, even in very young patients.
- Patient's anatomical size is the most critical factor in selecting instrumentation for cervical spine fusion.
- Established age limits for rigid instrumentation and sublaminar wiring can be lowered based on anatomical considerations.
