Posterior cervical-thoracic spinal fixation using mandibular instrumentation to treat acute cervical spine traumatic instability in the young pediatric population.

STUDY DESIGN

Retrospective review.

OBJECTIVE

Surgical fixation of the pediatric subaxial cervical spine poses significant challenges due to a mismatch between rigid adult cervical spine hardware and the size and shape of bone in a young (below 8 years of age) cervical spine.

SETTING

Arizona, USA.

METHODS

We conducted a retrospective review of our experience with subaxial cervical spine screw fixation using adult type mandibular instrumentation in pediatric patients younger than 8 years, symptomatic from acute traumatic cervical spine injury during the period of 2007 through 2023.

RESULTS

We identified 5 patients with the mean age of 4.4 years (range 2-6 years) who all had spinal cord injury with subluxation or dislocation at C6-7. All patients underwent posterior cervico-thoracic fixation with mandibular instrumentation from C2 to the upper thoracic spine. There was one complication of a right vertebral artery occlusion by screw placement, which did not cause harm. Suboptimal screw placement was detected in 18.4% of screws, but no revision was needed, since it was asymptomatic. All patients fused successfully without significant hardware failure. The mean time of follow up was 91 months ranging from 33-187 months.

CONCLUSIONS

Mandibular screw and plate fixation was effective to treat the acutely traumatic unstable subaxial cervical spine in the young pediatric population. The rate of suboptimal screw placement may be reduced by placing shorter screws into the lamina, pedicles, or facets if the plate hole does not align for a standard trajectory needed for lateral mass or pedicle screw placement.