Usefulness of ipsilateral translaminar C2 screws insertion for cervical fixation in children with a low laminar profile:
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TECHNICAL NOTE
Usefulness of ipsilateral translaminar C2 screws insertion for cervical fixation in children with a low laminar profile: a technical note Javier Orduna Martínez 1 & Laura B. López López 1 & Jesús A. Moles Herbera 1 & Juan Casado Pellejero 1 & David Fustero de Miguel 1 & Beatriz Curto Simón 2 Received: 20 July 2020 / Accepted: 22 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract 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 8year-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. Keywords C2 translaminar screws . Craniocervical junction . Cervical instrumentation . Pediatric patients . Atlantoaxial
Introduction There are various traumatic, malformative, tumorous, and other pathologies that may require cranio-cervical junction fixation in pediatric patients [1]. Various techniques have been described and employed to perform C1–C2 fixation in children [2]. Cervical screw fusions have shown a better rate of arthrodesis and better
biomechanical results than fusion techniques using wires and bone grafts [3, 4]. C2 fixation using translaminar screws was first described by Wright in 2004 [5] and has been added to the pediatric spinal surgeon’s surgical armamentarium as a safe and biomechanically efficient cervical fixation system. Posterior cranio-cervical junction fixation with C1 lateral mass screws and C2 crossing translaminar screws is not
Previous Presentations One of the cases was presented as a Poster in the EANS (European Association of Neurological Societies) meeting 2014. * Javier Orduna Martínez [email protected]
David Fustero de Miguel [email protected] Beatriz Curto Simón [email protected]
Laura B. López López [email protected] Jesús A. Moles Herbera [email protected]
1
Department of Neurosurgery, Universitary Hospital Miguel Servet, Paseo Isabel la Católica 1-3, 50009 Zaragoza, Spain
Juan Casado Pellejero jca
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