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C-2 translaminar screws offer high fusion rate, few complications
Among children 5 years old or younger, C-2 translaminar screws can be an effective tool for internal fixation of the upper cervical spine, according to study findings.
Researchers retrospectively reviewed 18 children who were treated with instrumented occipitocervical or C1–2 fusion. All of the children 5 years old or younger had at least one C-2 translaminar screw incorporated into their procedure. Mean follow-up was 17.5 months.
Overall, 24 C-2 laminar screws were used in the procedures, with 23 of the screws placed satisfactorily, or contained completely within the cortical walls. No complications due to screw placement were evident in any of the children; one screw failed due to a medial cortex breach without neurological impingement, according to the researchers.
Two patients died due to their original conditions, and three required wound revisions; 11 of the 12 patients available for 6 months of follow-up or longer showed significant radiographic stability or completion of fusion, the researchers found.
Disclosure: The authors have no relevant financial disclosures.
Perspective
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Use of C2 translaminar screws in the upper cervical spine in children is technically demanding. Several recent studies have shown that compared to adults, the benefits of C2 translaminar screws fixation are more obvious in the pediatric spine, which has a large C2 lamina. A modification to Wright’s technique, that screws are inserted with bigger insert angle using shorter screw length has been shown to be more safe and effective.
In this retrospective review of radiographic and clinical data in a cohort of 18 children (24 C2 screws), the authors showed there were no complications with screw placement except from one medial cortex breach without further neurological problems, and three wound problems requiring wound revision.
Although the sample size of this study is small, it seems that placement of C2 translaminar screws provide an effective anchor for internal fixation that may increase the fusion rates and reduce the need for halo fixation inchildren.