Use of a craniofacial miniplate for internal fixation in a young child with cervical instability

Commercially available anterior cervical internal fixation devices are desi gned for placement in adults and older children. Use of these systems in pr eschool-aged children is precluded due to the small size of their cervical vertebral bodies (VBs). The authors describe a 2-year-old boy who suffered a C3-4 injury, resulting in complete ligamentous disruption: Because of the gross cervical instability, they elected to perform surgery via posterior and anterior approaches, supplemented with internal fixation, during the sa me operation. The purpose of the anterior internal fixation device is to de liver compressive forces onto the interbody graft and keep it in place, thu s optimizing the potential for a successful fusion. Because of the discrepa ncy in size between the VBs and the plate and screws, however, the authors were unable to use any of the standard anterior cervical, fixation devices. Instead, they implanted a craniofacial miniplate, and the patient was requ ired to wear an external halo brace. The miniplate provided enough stabilit y to allow for a solid fusion. The authors believe that this technique is a reasonable option in young children who require anterior cervical fixation .