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World J Orthop. Apr 18, 2014; 5(2): 94-99
Published online Apr 18, 2014. doi: 10.5312/wjo.v5.i2.94
Modern posterior screw techniques in the pediatric cervical spine
Daniel J Hedequist
Daniel J Hedequist, Department of Orthopedic Surgery, Children’s Hospital Boston/Harvard Medical School, Boston, MA 02115, United States
Author contributions: Hedequist DJ solely contributed to this paper.
Correspondence to: Daniel J Hedequist, MD, Department of Orthopedic Surgery, Children’s Hospital Boston/Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, United States. daniel.hedequist@childrens.harvard.edu
Telephone: +1-617-3554847 Fax: +1-617-3554847
Received: November 13, 2013
Revised: January 16, 2014
Accepted: March 17, 2014
Published online: April 18, 2014
Abstract

Treatment of children with cervical spine disorders requiring fusion is a challenging endeavor for a variety of reasons. The size of the patients, the corresponding abnormal bony anatomy, the inherent ligamentous laxity of children, and the relative rarity of the disorders all play a part in difficulty of treatment. The benefits of modern posterior cervical instrumentation in children, defined as rigid screw-rod systems, have been shown to be many including: improved arthrodesis rates, diminished times in halo-vest immobilization, and improved reduction of deformities. The anatomy of children and the corresponding pathology seen frequently is at the upper cervical spine and craniocervical junction given the relatively large head size of children and the horizontal facets at these regions predisposing them to instability or deformity. Posterior screw fixation, while challenging, allows for a rigid base to allow for fusion in these upper cervical areas which are predisposed to pseudarthrosis with non-rigid fixation. A thorough understanding of the anatomy of the cervical spine, the morphology of the cervical spine, and the available screw options is paramount for placing posterior cervical screws in children. The purpose of this review is to discuss both the anatomical and clinical descriptions related to posterior screw placement in the cervical spine in children.

Keywords: Pediatric cervical spine, Cervical screw fixation, Posterior cervical techniques

Core tip: This paper reviews the techniques used for modern posterior screw fixation of the pediatric cervical spine. The preoperative considerations, necessary studies, and surgical techniques are reviewed in order to educate the reader on the use of modern screw fixation in the pediatric cervical spine. Upper cervical fixation techniques as well as lateral mass screw fixation in the subaxial spine are discussed.