C1-C2 fusion in children with atlantoaxial instability and spinal cord compression: technical note

Children with atlantoaxial instability and subluxation that will not reduce with extension of the cervical spine often present with clinical and/or radiographic evidence of spinal cord compression at the C1-C2 level. If the patient requires a laminectomy at the C1 level, occipital fusion is necessitated with associated reduction in mobility and high incidence of nonunion, as compared with a C1-C2 fusion. Also, passing wires under the intact lamina at C1 can further compromise an already compressed cervical cord. To address the problems associated with either of the above options, we used a C1-C2 fusion with removal of the mid 2 cm of the lamina of C1. Another option is the application of a transarticular screw fixation of C1-C2, which does not require the posterior element of C1. The current study was performed before the introduction of this type of fixation. Over a 10-year period, we have used the described technique to treat 13 patients. After decompression and fusion at the C1 and C2 levels as described, all patients had resolution of their preoperative neurological symptoms and all have achieved a stable fusion. Partial removal of the lamina at C1 and then C1-C2 fusion are safe and effective procedures to treat children with atlantoaxial instability and spinal cord compression.