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Modern instrumentation of the pediatric occiput and upper cervical spine: review article
1Department of Orthopedic Surgery, Children's Hospital Boston/Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115 USA.
Insights
Modern posterior cervical instrumentation safely treats pediatric cervical deformity. Thorough understanding of anatomy and meticulous surgical techniques ensure patient safety and improve fusion rates, reducing immobilization needs.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Rigid screw rod techniques are standard for adult cervical stabilization, offering benefits like improved fusion rates and deformity correction.
- Applying these techniques in pediatric patients presents challenges due to anatomical constraints and specific pathologies requiring instrumented fusions.
- Detailed anatomical knowledge and surgical preparation are crucial for safe pediatric cervical fusion procedures.
Purpose of the Study:
- To provide an educational overview of contemporary posterior instrumentation methods for pediatric cervical deformity.
- To serve as a guide for surgeons utilizing these advanced techniques in young patients.
Main Methods:
- This review is based on expert clinical experience and a comprehensive literature review.
- Analysis of current posterior instrumentation techniques applicable to the pediatric cervical spine.
Main Results:
- Discusses the application of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine.
- Reviews essential preoperative imaging requirements for pediatric cervical spine surgery.
- Details the anatomy, morphologic considerations, and surgical techniques for each instrumentation area.
Conclusions:
- Modern posterior cervical instrumentation is safe and effective for most pediatric patients needing instrumented posterior cervical fusion.
- Patient safety is enhanced through meticulous preoperative imaging, a deep understanding of upper cervical anatomy, and precise surgical technique.
- Contemporary instrumentation improves fusion success rates and minimizes the need for prolonged immobilization.
Background:
Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical techniques is paramount to surgical safety in pediatric patients.
Questions/Purposes:
This review article serves as an educational tool regarding the use of modern posterior instrumentation techniques for pediatric cervical deformity.
Methods:
Expert review based on clinical expertise and literature review.
Results:
The use of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine is discussed. Preoperative imaging requirements for pediatric patients undergoing cervical spine surgery are reviewed. Anatomy, morphologic studies, and surgical techniques are discussed for each area of instrumentation.
Conclusions:
Modern posterior cervical instrumentation techniques can be safely applied to the majority of pediatric patients who require an instrumented posterior cervical fusion. Patient safety revolves around thorough preoperative imaging tests, understanding of upper cervical anatomy, and meticulous surgical technique. Modern instrumentation leads to an improvement in fusion rates and a diminishment in immobilization requirements.
