Background: Craniovertebral junction (CVJ) instrumentation and fusion in childhood are frequently performed with either sublaminar wires or screws in lateral masses, and both are considered quite safe procedures.
Methods: Our experience deals with 12 children: six (mean age 9.5 years) harbouring a congenital instability associated with Down’s or Morquio’s syndromes and primary os odontoideum; and six (mean age 11.5 years) with acquired iatrogenic instability due to transoral anterior decompression for different reasons (inferior clivectomy, anterior arch removal and odontoidectomy). All patients in the ‘congenital group’, except for one, had preoperative dynamic x-rays and underwent surgical correction by means of posterior wiring, fusion and an external orthosis. All patients in the ‘iatrogenic group’ had no preoperative dynamic x-rays and underwent a screwing technique with fusion and an external orthosis.
Results: The postoperative clinical picture had improved in all patients at the latest follow-up (observation range 63–202 months [mean 118.5 months]), with neuroradiological confirmation of satisfactory bony fusion and with neural decompression in all patients.
Conclusion: Although it requires a more accurate preoperative neuroradiological setting, the screwing technique takes less time and is characterized by less blood loss and less postoperative discomfort than the wiring technique. The latter features confirm the simplicity, safety (continuous fluoroscopic assistance is not necessary, and there is no risk of neurovascular injuries) and lower expense (neither complex hardware devices nor neuronavigation systems are required) of the screwing technique.
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The authors declare that they have no competing interests.
Compliance with Ethical Standards
No financial support was received for this work.
Visocchi M, Doglietto F, Della Pepa GM, Esposito G, La Rocca G, Di Rocco C, Maira G, Fernandez E. Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. Eur Spine J. 2011;20:1518–25.CrossRefGoogle Scholar
Visocchi M, Della Pepa GM, Doglietto F, Esposito G, La Rocca G, Massimi L. Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood. Childs Nerv Syst. 2011;27(5):825–31.CrossRefGoogle Scholar
Visocchi M. Advances in videoassisted anterior surgical approach to the craniovertebral junction. Adv Tech Stand Neurosurg. 2011;37:97–110.CrossRefGoogle Scholar
Visocchi M, Fernandez EM, Ciampini A, Di Rocco C. Reducible and irreducible os odontoideum treated with posterior wiring, instrumentation and fusion. Past or present? Acta Neuroch (Wien). 2009;151(10):1265–74.CrossRefGoogle Scholar
Visocchi M, Di Rocco F, Meglio M. Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience. Acta Neurochir. 2003;145:265–72.CrossRefGoogle Scholar
Frankel HC, Hancock DO, Hyslop G. The value of postural reduction in the initial management of closed injures of the spine with paraplegia and tetraplegia. Paraplegia. 1969;7:179–1932.PubMedGoogle Scholar
Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications and lessons learned in 67 paediatric patients. J Neurosurg Spine. 2005;2:164–9.CrossRefGoogle Scholar
Magerl F, Seman PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, editor. Cervical spine. New York: Springer; 1987. p. 322–7.CrossRefGoogle Scholar
Diaz JH, Belani KG. Perioperative management of children with mucopolysaccharidoses. Anesth Analg. 1993;77:1261–70.CrossRefGoogle Scholar
Lorenzo D. Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta Neuroch. 1992;118:112–6.CrossRefGoogle Scholar
Grob D. Occipitocervical fusion in patients with rheumatoid arthritis. Clin Orthop. 1999;366:46–53.CrossRefGoogle Scholar
Grob D, Dvorak J, Panjabi M. Posterior occipitocervical fusion. A preliminary report of a new technique. Spine. 1991;16(3 Suppl):17–24.CrossRefGoogle Scholar
Grob D, Dvorak J, Panjabi MM, Antinnes JA. The role of plate and screw fixation in occipitocervical fusion in rheumatoid arthritis. Spine. 1994;15:2545–51.CrossRefGoogle Scholar
Hensinger RN. Congenital anomalies of the cervical spine. Clin Orthop. 1991;64:16–38.Google Scholar
Oda I, Abumi K, Sell LC, Haggerty CJ, Cunningham BW, McAfee PC. Biomechanical evaluation of five different occipito-atlanto-axial fixation technique. Spine. 1999;24:2377–82.CrossRefGoogle Scholar
Smith MD, Anderson P, Grady MS. Occipitocervical arthrodesis using contoured plate fixation, an early report on a versatile fixation technique. Spine. 1993;18(14):1984–90.CrossRefGoogle Scholar
Vale E. Rigid occipitocervical fusion. J Neursurg. 1999;91(2 Suppl):144–50.Google Scholar
Cahill D. Posterior occipital reconstruction using cervical pedicle screw and plate–rod system. Spine 15. 2000;24(14):1425–34.Google Scholar
Grob D, Janneret B, Aebi M. Atlantoaxial fusion with transarticular screw fixation. J Bone Joint Surg. 1991;73B:972–6.CrossRefGoogle Scholar
Dickman CA. Occipitocervical wiring techniques. In: Surgery of the craniovertebral junction. New York: Thieme; 1998. p. 795–808.Google Scholar
Menezes AH. Occipito-cervical fusion: indications, technique and avoidance of complications. In: Hitchon PW, editor. Techniques of spinal fusion and stabilisation. New York: Thieme; 1994. p. 82–91.Google Scholar
Segal LE, Drummond DS, Zanotti RM. Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome. J Bone Joint Surg Am. 1991;73:1547–54.CrossRefGoogle Scholar
Ryken TC, Menezes AH. Abnormailities of the craniovertebral junction in Down’s syndrome. In: Principles of spinal surgery. New York: McGraw Hill; 1995. p. 395–409.Google Scholar
Visocchi M, Trevisi G, Iacopino DG, Tamburrini G, Caldarelli M, Barbagallo GM. Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of “accordion phenomenon”. Eur Spine J. 2015;24(Suppl 4):S564–8.CrossRefGoogle Scholar
Visocchi M, Mattogno PP, Signorelli F, Zhong J, Iacopino G, Barbagallo G. Complications in craniovertebral junction instrumentation: hardware removal can be associated with long-lasting stability. Personal experience. Acta Neurochir Suppl. 2017;124:187–94.CrossRefGoogle Scholar