Wiring or Screwing at the Craniovertebral Junction in Childhood: Past and Present Personal Experience

Area of Science:

• Pediatric Neurosurgery
• Spinal Surgery
• Orthopedic Surgery

Background:

• Craniovertebral junction (CVJ) instrumentation and fusion in children commonly utilize sublaminar wires or lateral mass screws.
• Both sublaminar wiring and lateral mass screw techniques are considered safe for pediatric CVJ stabilization.

Purpose of the Study:

• To compare the outcomes of sublaminar wiring versus lateral mass screw techniques for craniovertebral junction (CVJ) instrumentation and fusion in pediatric patients.
• To evaluate the safety, efficacy, and resource utilization of two distinct surgical approaches for CVJ instability in children.

Main Methods:

• A retrospective review of 12 pediatric patients undergoing CVJ fusion was conducted.
• Six patients with congenital instability (Down's syndrome, Morquio's syndrome, os odontoideum) were treated with posterior wiring and fusion.
• Six patients with iatrogenic instability (post-decompression) were treated with lateral mass screw fixation and fusion.

Main Results:

• All 12 patients demonstrated improved clinical outcomes postoperatively, with a mean follow-up of 118.5 months.
• Neuroradiological assessment confirmed satisfactory bony fusion and successful neural decompression in all cases.
• The screwing technique group experienced less operative time, reduced blood loss, and decreased postoperative discomfort compared to the wiring group.

Conclusions:

• The screwing technique for CVJ fusion in children is associated with reduced operative time, blood loss, and postoperative discomfort.
• While requiring precise preoperative imaging, the screwing technique offers advantages in simplicity, safety (no neurovascular injury risk), and lower cost.
• Both wiring and screwing techniques achieve satisfactory bony fusion and clinical improvement in pediatric CVJ instability.