Surgery for upper cervical spine instabilities in children

Background. Due to the paucity of existing data with regard to surgical fus ion of upper cervical spine instabilities in the paediatric population, we feel encouraged to report the results of our own series to provide addition al information to the available body of literature. Methods. Since 1991 N = I I children underwent a total of N = 13 surgical p rocedures for N = 8 posttraumatic, N = 2 congenital and N = I postinfectiou s instabilities at a mean age of 10 years (range: 3-16 years). Transoral od ontectomies, ventral odontoid screw-fixations, dorsal wiring or -clamping a nd transarticular screw-fixations were performed for stabilization and ilia c crest bone graft used for fusion. Pain scores, neurological status and ra diological results were documented at regular intervals (mean follow-up: 25 .4 months). Results. Stable fusion was achieved in all patients as documented on flexio n/extension films and tomographies. At the latest follow-up N = 2 patients had improved and N = 9 were equal to their preoperative neurological status . Pain scores were improved in N = 9 patients. N = 2 children developed "by stander-fusion" after C0/2 wiring, N = 3 peri-operative complications occur red as transient neurological deteriorations. In one case this resulted fro m the resection of a lower brainstem tumour prior to the stabilization proc edure. One was attributed to sublaminar wiring in the case of an os odontoi deum and one occurred due to slippage of the halo orthosis after transoral odontectomy before definitive dorsal stabilization was carried out, Interpretation. In accordance with the recent literature, we argue for the application of modern screw fixations and treatment algorithms as establish ed for adults in upper cervical spine instabilities of older children. Tech niques and indications remain problematic for those younger than 6 years an d may have to be individualized in congenital instabilities.