APPLICATION OF PEDICLE SCREW INTERNAL FIXATION FOR ATLANTOAXIAL INSTABILITY OF CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIAOYehui ,  ZHONGDejun , WANGQing , LISen , ZHANGYi , WANGGaoju

Department of Spinal Surgery, the Affiliated Hospital of Luzhou Medical College, Luzhou Sichuan, 646000, P. R. China;

Corresponding author：

ZHONGDejun, Email: zdj_1974@163.com

Keywords：

Atlantoaxial instability; Pedicle screw; Internal fixation; Children

DOI：

10.7507/1002-1892.20140123

Video：

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Objective To investigate the effectiveness of pedicle screw internal fixation for the atlantoaxial instability of children. Methods Between July 2005 and January 2012, 19 cases of atlantoaxial instability were treated, included 10 boys and 9 girls with an average age of 7.5 years (range, 4-15 years). The X-ray films, CT, and MRI examinations of the cervical spine showed craniocervical malformation in 9 cases, congenital os odontoideum in 3 cases, odontoid fracture (type Ⅱ) in 1 case, disruption of transverse ligament in 2 cases, atlantoaxial fracture and dislocation in 4 cases; and spinal cord injury in 8 cases, according to the American Spinal Cord Injury Association (ASIA) impairment scale, 1 case was rated as grade B, 2 as grade C, and 5 as grade D. Preoperative skull traction was performed routinely on all cases, and complete reduction was achieved in 17 cases, no reduction in 2 cases. In 17 patients who achieved complete reduction, pedicle screw internal fixation was used through posterior approach, including occipitocervical fusion and fixation in 5 cases, and atlantoaxial fusion and fixation in 12 cases; in 2 patients with no reduction, pedicle screw internal fixation was used through posterior approach (atlantoaxial fusion and fixation) after release by transoral approach. Results The operation was successfully performed in all patients. The mean operation time was 89 minutes; the mean intraoperative blood loss was 95 mL; the mean postoperative drainage volume was 73 mL; and the mean hospitalization days were 14 days. The patients were followed up 6-27 months (mean, 18.3 months). Satisfactory atlantoaxial fusion was obtained, and bone fusion was obtained at 3-7 months after operation (mean, 4.5 months). No breakage of screw or rods and re-dislocation occurred during follow-up. At last follow-up, the cervical range of motion (CROM) of the left and right rotation were (62.0±5.9)°and (63.9±3.8)°respectively in 5 patients receiving occipitocervical fusion and fixation, showing significant difference when compared with the values of normal children[(72.3±7.0)°and (74.1±7.6)°, respectively] at the same age (t=-3.915, P=0.018; t=-5.954, P=0.004). The CROM of the left and right rotation were (70.5±5.8)°and (72.7±4.9)°respectively in 14 patients receiving atlantoaxial fusion and fixation, showing no significant difference when compared with normal children at the same age (t=-1.417, P=0.180; t=-1.021, P=0.323). The visual analogue scale (VAS) score was significantly decreased from 7.8±1.1 at pre-operation to 3.5±0.8 at last follow-up (t=17.267, P=0.000). In 8 cases having spinal cord injury, 2 cases were rated as grade C, 1 case as grade D, and 5 cases as grade E according to ASIA impairment scale. Conclusion Technique of pedicle screw internal fixation has been proven to be an effective treatment for the atlantoaxial instability of children. It plays an important part in relieving pain and limitation of the cervical region.

Citation： LIAOYehui, ZHONGDejun, WANGQing, LISen, ZHANGYi, WANGGaoju. APPLICATION OF PEDICLE SCREW INTERNAL FIXATION FOR ATLANTOAXIAL INSTABILITY OF CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(5): 549-553. doi: 10.7507/1002-1892.20140123 Copy

1.	Ahmed R, Traynelis VC, Menezes AH. Fusions at the craniovertebral junction. Childs Nerv Syst, 2008, 24(10):1209-1224.
2.	Ghanem I, El Hage S, Rachkidi R, et al. Pediatric cervical spine instability. J Child Orthop, 2008, 2(2):71-84.
3.	Khanna G, El-Khoury GY. Imaging of cervical spine injuries of childhood. Skeletal Radiol, 2007, 36(6):477-494.
4.	Christensen DM, Eastlack RK, Lynch JJ, et al. C₁ anatomy and dimensions relative to lateral mass screw placement. Spine (Phila Pa 1976), 2007, 32(8):844-848.
5.	Liu J, Napolitano JT, Ebraheim NA. Systematic review of cervical pedicle dimensions and projections. Spine (Phila Pa 1976), 2010, 35(24):E1373-1380.
6.	Resnick DK, Lapsiwala S, Trost GR. Anatomic suitability of the C₁-C₂ complex for pedicle screw fixation. Spine (Phila Pa 1976), 2002, 27(14):1494-1498.
7.	Harms J, Melcher RP. Posterior C₁-C₂ fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976), 2001, 26(22):2467-2471.
8.	马维虎, 刘观燚, 徐荣明, 等. 寰椎椎弓根螺钉及枢椎椎板螺钉固定植骨融合治疗创伤性上颈椎不稳. 中国脊柱脊髓杂志, 2010, 20(3):214-218.
9.	刘晓岚, 周若舟, 刘社庭, 等. 枢椎椎弓峡部引导下寰椎椎弓根置钉的CT测量及其应用. 中国脊柱脊髓杂志, 2010, 20(11):930-934.
10.	Youdas JW, Garrett TR, Suman VJ, et al. Normal range of motion of the cervical spine:an initial goniometric study. Phys Ther, 1992, 72(11):770-780.
11.	Ogden JA. 儿童骨骼损伤. 柳用墨, 译. 北京:人民卫生出版社, 1987:274-275.
12.	校佰平, 徐荣明. 寰枢椎经椎弓根螺钉固定技术的临床应用. 中国脊柱脊髓杂志, 2005, 15(11):658-661.
13.	Rahimi SY, Stevens EA, Yeh DJ, et al. Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus, 2003, 15(6):ECP1.
14.	范少勇, 邹鸿星, 杨淮河, 等. 寰枢椎椎弓根钉棒内固定治疗创伤后寰枢椎不稳. 江西医药, 2009, 44(8):757-759.
15.	Dickman CA, Sonntag VK. Posterior C₁-C₂ transarticular screw fixation for atlantoaxial arthrodesis. J Neurosurgery, 1998, 43(2):275-280.
16.	左春光, 刘夏君, 王新虎, 等. 经后路寰枢椎椎弓根螺钉固定融合术治疗寰枢椎失稳. 中国骨伤, 2013, 26(1):33-37.
17.	Hwang SW, Gressot LV, Rangel-Castilla L, et al. Outcomes of instrumented fusion in the pediatric cervical spine. J Neurosurg Spine, 2012, 17(5):397-409.
18.	胡勇, 徐荣明, 马维虎, 等. 不稳性寰椎骨折的外科治疗策略. 中国创伤杂志, 2011, 27(2):115-120.
19.	贾连顺, 袁文. 颈椎外科学. 北京:人民卫生出版社, 2009:268.
20.	马向阳, 钟世镇, 刘景发, 等. 寰椎椎弓根螺钉进钉点的解剖定位研究. 骨与关节损伤杂志, 2003, 18(10):683-685.
21.	谭明生, 唐向盛, 移平, 等. 寰椎椎弓根显露置钉法的临床应用. 脊柱外科杂志, 2011, 9(3):148-152.
22.	Sanders JO, Herring JA, Browne RH. Posterior arthrodesis and instrumentation in the immature (Risser-grade-0) spine in idiopathic scoliosis. J Bone Joint Surg (Am), 1995, 77(1):39-45.
23.	Rodgers WB, Coran DL, Kharrazi FD, et al. Increasing lordosis of the occipitocervical junction after arthrodesis in young children:the occipitocervical crankshaft phenomenon. J Pediatr Orthop, 1997, 17(6):762-765.
24.	Moorthy RK, Rajshekhar V. Changes in cervical spine curvature in pediatric patients following occipitocervical fusion. Childs Nerv Syst, 2009, 25(8):961-967.
25.	Roberto RF, Lonstein JE, Winter RB, et al. Curve progression in Risser stage 0 or 1 patients after posterior spinal fusion for idiopathic scoliosis. J Pediatr Orthop, 1997, 17(6):718-725.
26.	Sanders JO, Little DG, Richards BS. Prediction of the crankshaft phenomenon by peak height velocity. Spine (Phila Pa 1976), 1997, 22(12):1352-1356.
27.	谭明生, 唐向盛, 王文军, 等. 寰枢椎椎弓根螺钉内固定术治疗儿童寰枢椎脱位的初步报告. 中国脊柱脊髓杂志, 2012, 22(2):131-136.

1. Ahmed R, Traynelis VC, Menezes AH. Fusions at the craniovertebral junction. Childs Nerv Syst, 2008, 24(10):1209-1224.
2. Ghanem I, El Hage S, Rachkidi R, et al. Pediatric cervical spine instability. J Child Orthop, 2008, 2(2):71-84.
3. Khanna G, El-Khoury GY. Imaging of cervical spine injuries of childhood. Skeletal Radiol, 2007, 36(6):477-494.
4. Christensen DM, Eastlack RK, Lynch JJ, et al. C₁ anatomy and dimensions relative to lateral mass screw placement. Spine (Phila Pa 1976), 2007, 32(8):844-848.
5. Liu J, Napolitano JT, Ebraheim NA. Systematic review of cervical pedicle dimensions and projections. Spine (Phila Pa 1976), 2010, 35(24):E1373-1380.
6. Resnick DK, Lapsiwala S, Trost GR. Anatomic suitability of the C₁-C₂ complex for pedicle screw fixation. Spine (Phila Pa 1976), 2002, 27(14):1494-1498.
7. Harms J, Melcher RP. Posterior C₁-C₂ fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976), 2001, 26(22):2467-2471.
8. 马维虎, 刘观燚, 徐荣明, 等. 寰椎椎弓根螺钉及枢椎椎板螺钉固定植骨融合治疗创伤性上颈椎不稳. 中国脊柱脊髓杂志, 2010, 20(3):214-218.
9. 刘晓岚, 周若舟, 刘社庭, 等. 枢椎椎弓峡部引导下寰椎椎弓根置钉的CT测量及其应用. 中国脊柱脊髓杂志, 2010, 20(11):930-934.
10. Youdas JW, Garrett TR, Suman VJ, et al. Normal range of motion of the cervical spine:an initial goniometric study. Phys Ther, 1992, 72(11):770-780.
11. Ogden JA. 儿童骨骼损伤. 柳用墨, 译. 北京:人民卫生出版社, 1987:274-275.
12. 校佰平, 徐荣明. 寰枢椎经椎弓根螺钉固定技术的临床应用. 中国脊柱脊髓杂志, 2005, 15(11):658-661.
13. Rahimi SY, Stevens EA, Yeh DJ, et al. Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus, 2003, 15(6):ECP1.
14. 范少勇, 邹鸿星, 杨淮河, 等. 寰枢椎椎弓根钉棒内固定治疗创伤后寰枢椎不稳. 江西医药, 2009, 44(8):757-759.
15. Dickman CA, Sonntag VK. Posterior C₁-C₂ transarticular screw fixation for atlantoaxial arthrodesis. J Neurosurgery, 1998, 43(2):275-280.
16. 左春光, 刘夏君, 王新虎, 等. 经后路寰枢椎椎弓根螺钉固定融合术治疗寰枢椎失稳. 中国骨伤, 2013, 26(1):33-37.
17. Hwang SW, Gressot LV, Rangel-Castilla L, et al. Outcomes of instrumented fusion in the pediatric cervical spine. J Neurosurg Spine, 2012, 17(5):397-409.
18. 胡勇, 徐荣明, 马维虎, 等. 不稳性寰椎骨折的外科治疗策略. 中国创伤杂志, 2011, 27(2):115-120.
19. 贾连顺, 袁文. 颈椎外科学. 北京:人民卫生出版社, 2009:268.
20. 马向阳, 钟世镇, 刘景发, 等. 寰椎椎弓根螺钉进钉点的解剖定位研究. 骨与关节损伤杂志, 2003, 18(10):683-685.
21. 谭明生, 唐向盛, 移平, 等. 寰椎椎弓根显露置钉法的临床应用. 脊柱外科杂志, 2011, 9(3):148-152.
22. Sanders JO, Herring JA, Browne RH. Posterior arthrodesis and instrumentation in the immature (Risser-grade-0) spine in idiopathic scoliosis. J Bone Joint Surg (Am), 1995, 77(1):39-45.
23. Rodgers WB, Coran DL, Kharrazi FD, et al. Increasing lordosis of the occipitocervical junction after arthrodesis in young children:the occipitocervical crankshaft phenomenon. J Pediatr Orthop, 1997, 17(6):762-765.
24. Moorthy RK, Rajshekhar V. Changes in cervical spine curvature in pediatric patients following occipitocervical fusion. Childs Nerv Syst, 2009, 25(8):961-967.
25. Roberto RF, Lonstein JE, Winter RB, et al. Curve progression in Risser stage 0 or 1 patients after posterior spinal fusion for idiopathic scoliosis. J Pediatr Orthop, 1997, 17(6):718-725.
26. Sanders JO, Little DG, Richards BS. Prediction of the crankshaft phenomenon by peak height velocity. Spine (Phila Pa 1976), 1997, 22(12):1352-1356.
27. 谭明生, 唐向盛, 王文军, 等. 寰枢椎椎弓根螺钉内固定术治疗儿童寰枢椎脱位的初步报告. 中国脊柱脊髓杂志, 2012, 22(2):131-136.

Chinese Journal of Reparative and Reconstructive Surgery

APPLICATION OF PEDICLE SCREW INTERNAL FIXATION FOR ATLANTOAXIAL INSTABILITY OF CHILDREN

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