Javier Orduna Martínez1, Laura B López López2, Jesús A Moles Herbera2, Juan Casado Pellejero2, David Fustero de Miguel2, Beatriz Curto Simón3. 1. Department of Neurosurgery, Universitary Hospital Miguel Servet, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain. jordunam@hotmail.com. 2. Department of Neurosurgery, Universitary Hospital Miguel Servet, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain. 3. Department of Pediatrics, Universitary Hospital Miguel Servet, Paseo Isabel la Católica 1-3, 50009, Zaragoza, Spain.
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 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.
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.