Upper Cervical Techniques: Pediatric Wiring

Abstract

Surgery can be required even in very young kids to treat many pathologies of the occipito-cervical junction. Reduction of displacement and stabilization need fixation and fusion.

Local anatomy doesn’t allow classical fixation (as hooks or screw due to the size of the vertebrae or remaining growth cartilage). O-C1-C2 or C-C2 wiring may be a solution, even though it has been demonstrated that it was not the better biomechanical construct. A perfect knowledge of the anatomy is necessary.

Surgical Technique:

A cortical graft, after decortication of the posterior arch of C1 and upper part of lamina of C2, is either simply applied or embedded, maintained by the wire.

Tension must be applied on the wire but without:

• Excessive tension which increases local hyperlordosis and risk of “cheese wire effect”.

• Insufficiency tension which leaves local kyphosis and risk or graft dislodgement.

Immobilization by halo cast or halo brace is necessary at least 2 months after surgery.

Conclusion:

This easy technique is still used in very young kids and remains helpful in numerous cases.