Occipital Plate Fixation in the Pediatric Population
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Updated: Dec 23, 2025
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Published on: May 16, 2025
Lara L Cohen1, Brian W Yang, Michael P Glotzbecker
1Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
Insights
Occipital plate fixation is a safe and effective method for pediatric cervical spine fusion, even in complex cases. This study found it successful in a diverse group of young patients, with low complication rates.
Area of Science:
- Orthopaedic Surgery
- Pediatric Spine Surgery
- Cervical Spine Fusion
Background:
- Occipital plate fixation is recognized for improving cervical spine fusion outcomes.
- Literature on occipital plate use in pediatric populations is limited.
- This study examines occipital plate fixation in a pediatric case series.
Purpose of the Study:
- To describe the utility of occipital plates in achieving cervical spine union.
- To evaluate the safety and efficacy of occipital plate fixation in pediatric patients.
- To analyze outcomes in a diverse cohort of children undergoing cervical spine fusion.
Main Methods:
- A retrospective review of 34 pediatric patients undergoing cervical spine fusion with occipital plate fixation (2003-2016).
- Data collected included diagnoses, fusion levels, surgical technique, hospitalization duration, and complications.
- Level IV evidence: case series.
Main Results:
- The study included 34 pediatric patients (mean age 10.9 years) with various diagnoses (e.g., trisomy 21, Klippel-Feil syndrome).
- Indications included cervical instability, basilar invagination, and os odontoideum.
- No intraoperative complications or implant-related issues were reported; 2 cases of nonunion occurred, successfully treated with revision surgery.
Conclusions:
- Occipital plate fixation demonstrated success in pediatric cervical spine fusion for a complex patient group.
- The primary complication was delayed union or nonunion (12%), with no plate-related issues.
- Occipital plate fixation is a safe and effective surgical option for pediatric patients with complex spinal diagnoses.
Background:
Occipital plate fixation has been shown to improve outcomes in cervical spine fusion. There is a paucity of literature describing occipital plate fixation, especially in the pediatric population. The authors reviewed a case series of 34 patients at a pediatric hospital who underwent cervical spine fusion with occipital plate fixation between 2003 and 2016. This study describes how occipital plates aid the cervical spine union in a case series of diverse, complex pediatric patients.
Methods:
Our orthopaedic database at our institution was queried for patients undergoing an instrumented cervical spine procedure between 2003 and 2016. Medical records were used to collect diagnoses, fusion levels, surgical technique, and length of hospitalization, neurophysiological monitoring, complications, and revision procedures.
Results:
Thirty-four patients met the inclusion criteria. The mean age was 10.9 years (range, 3-21 y). Indications for surgery included cervical instability, basilar invagination, and os odontoideum. These indications were often secondary to a variety of diagnoses, including trisomy 21, Klippel-Feil syndrome, and rheumatoid arthritis. The mean length of hospitalization was 10 days (range, 2 to 80 d). There were no cases of intraoperative dural leak, venous sinus bleeding from occipital screw placement, or implant-related complications. Postoperative complications included 2 cases of nonunion. Eight patients (24%) had follow-up surgery, only 3 (9%) of which were instrumentation revisions. Both patients with nonunion had repeat occipitocervical fixation procedures and achieved union with revision.
Conclusions:
Occipital plate fixation was successful for pediatric cervical spine fusion in this diverse cohort. The only procedure-related complication demonstrated was delayed union or nonunion and implant loosening (4/34, 12%) and there were no plate-related complications. This novel case series shows that occipital plate fixation is safe and effective for pediatric patients with complex diagnoses.
Level Of Evidence:
Level IV-case series.
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