Related Experiment Video
Updated: Feb 22, 2026
Eye Tracking Young Children with Autism
Published on: March 27, 2012
Temporary occipital fixation in young children with severe cervical-thoracic spinal deformity
Brian J Kelley1,2, Anas A Minkara2, Peter D Angevine1
1Department of Neurological Surgery, Neurological Institute; and.
Insights
This study introduces a novel surgical technique for pediatric spinal instability, temporarily fusing the occiput to the thoracic spine. This method preserves craniovertebral junction (CVJ) growth and motion in young children.
Area of Science:
- Pediatric Neurosurgery
- Spinal Surgery
- Orthopedic Surgery
Background:
- Long-term effects of occipital-cervical-thoracic fusion on pediatric spinal growth are not well understood.
- Severe cervical-thoracic instability poses risks to spinal development in children.
Purpose of the Study:
- To present a novel surgical technique for severe pediatric spinal instability.
- To assess the impact of temporary occipital instrumentation on spinal growth and motion.
Main Methods:
- Four children with severe cervical-thoracic instability underwent posterior segmental instrumentation from occiput to thoracic spine.
- Bone graft was limited to C-2 and distal segments, avoiding the craniovertebral junction (CVJ).
- Occipital instrumentation was removed after fusion was confirmed at C-2, preserving CVJ motion and growth.
Main Results:
- Temporary occipital fixation provided biomechanical stability for spinal stabilization.
- Follow-up demonstrated partial restoration of motion at the CVJ after instrumentation removal.
- No unintended fusion occurred from the occiput to C-2 in the treated patients.
Conclusions:
- Temporary occipital fixation is a viable strategy for young children requiring extended spinal stabilization.
- This technique allows for continued spinal growth and motion at the CVJ.
- It can be considered for pediatric patients needing temporary stabilization without permanent fusion of the CVJ.
Abstract:
OBJECTIVE The long-term effects of instrumentation and fusion of the occipital-cervical-thoracic spine on spinal growth in young children are poorly understood. To mitigate the effects of this surgery on the growing pediatric spine, the authors report a novel technique used in 4 children with severe cervical-thoracic instability. These patients underwent instrumentation from the occiput to the upper thoracic region for stabilization, but without bone graft at the craniovertebral junction (CVJ). Subsequent surgery was then performed to remove the occipital instrumentation, thereby allowing further growth and increased motion across the CVJ. METHODS Three very young children (15, 30, and 30 months old) underwent occipital to thoracic posterior segmental instrumentation due to cervical or upper thoracic dislocation, progressive kyphosis, and myelopathy. The fourth child (10 years old) underwent similar instrumentation for progressive cervical-thoracic scoliosis. Bone graft was placed at and distal to C-2 only. After follow-up CT scans demonstrated posterior arthrodesis without unintended fusion from the occiput to C-2, 3 patients underwent removal of the occipital instrumentation. RESULTS Follow-up cervical spine flexion/extension radiographs demonstrated partial restoration of motion at the CVJ. One patient has not had the occipital instrumentation removed yet, because only 4 months have elapsed since her operation. CONCLUSIONS Temporary fixation to the occiput provides increased biomechanical stability for spinal stabilization in young children, without permanently eliminating motion and growth at the CVJ. This technique can be considered in children who require longer instrumentation constructs for temporary stabilization, but who only need fusion in more limited areas where spinal instability exists.
