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Usefulness of ipsilateral translaminar C2 screws insertion for cervical fixation in children with a low laminar
Javier Orduna Martínez1, Laura B López López2, Jesús A Moles Herbera2
1Department of Neurosurgery, Universitary Hospital Miguel Servet, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain. jordunam@hotmail.com.
Insights
This study introduces a modified translaminar C2 screw technique for pediatric upper cervical spine fusion, offering a safe alternative for complex cases. The technique demonstrated good clinical outcomes in two young patients with challenging cranio-cervical anatomy.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Upper cervical spine fusion in children presents unique challenges due to small anatomical size, complexity, and severe pathologies.
- Standard C1-C2 or occipito-C2 fixation techniques can be risky or impossible in some pediatric patients.
Purpose of the Study:
- To present the utility and outcomes of an ipsilateral laminar C2 screw insertion technique in pediatric patients.
- To offer a viable alternative for upper cervical fixation when standard methods are contraindicated.
Main Methods:
- The study involved two pediatric cases with low C2 laminar profiles requiring upper cervical fixation.
- A modified translaminar C2 screw technique was employed, combined with occipital plating in one case.
Main Results:
- Both pediatric patients achieved good clinical results during follow-up periods of 7 and 2 years.
- The technique proved feasible and effective in stabilizing the upper cervical spine.
Conclusions:
- The described ipsilateral translaminar C2 screw insertion is a feasible and effective alternative for pediatric upper cervical spine fusion.
- This technique is particularly valuable when patient anatomy precludes the use of or increases risks associated with standard fixation methods.
Purpose:
The fusion of the upper cervical spine in children is demanding due to its reduced size, its anatomical complexity, or a severe pathology of the cranio-cervical junction. In some pediatric patients with today's more popular C1-C2 or, occipito-C2 techniques, it is impossible, or very risky to perform a short upper cervical fixation.
Methods:
We present the utility and good results of ipsilateral laminar C2 screws insertion technique in two pediatric cases with low C2 laminar profile. Case 1: a 5-year-old child with a C1-C2 unstable subluxation, and a condylar assimilation of C1, where we performed an occipito-C2 fixation using an occipital plate and this modified translaminar C2 screw technique. Case 2: a 8-year-old Down syndrome boy who suffered an unstable subluxation of C1-C2 upon whom we performed a C1-C2 screw fixation using the same technique.
Results:
Both cases have been followed up over a period of 7 and 2 years respectively, with good clinical results.
Conclusions:
We describe the technique and the feasibility of the ipsilateral insertion of translaminar C2 screws in children with low laminar profiles, as a good alternative to other techniques when the anatomy of the C2 does not permit its use or make them very risky.
