Atlantoaxial posterior fixation is a well-described technique for instability in the adult population. Although also described in the pediatric population, smaller bony anatomy, synchondroses, and broad pathological conditions make this technique more challenging compared to adults. Here, we describe a young female patient who presented with a traumatic anterior atlas fracture after a previous suboccipital craniectomy with a C1 laminectomy. An instrumented fusion with C1 lateral mass and C2 pars screws was chosen to stabilize her upper cervical spine. Thin cut CT scans with sagittal reconstructions and a cervical MRI were obtained to provide a thorough review of the vertebral arteries and the C2 pars and C1 lateral mass lengths and diameters. Various indications, considerations, and techniques for C1–2 fixation in the pediatric population are discussed in entry ***.
Pars Screws Posterior Atlantoaxial Fixation Anterior Arch Fracture Lateral Mass Screw Placement Extensive Preoperative Imaging
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References and Suggested Reading
Anderson RC, Ragel BT, Mocco J et al (2007) Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients. J Neurosurg 107(1 Suppl):36–42PubMedGoogle Scholar
AuYong N, Piatt J Jr (2009) Jefferson fractures of the immature spine. Report of 3 cases. J Neurosurg Pediatr 3(1):15–19CrossRefGoogle Scholar
Baghdassarian A, Paitt JH, Giordano K (2014) Fracture of the anterior arch of atlas after minor trauma of the immature spine postlaminectomy. Pediatr Emerg Care 30(5):340–342CrossRefGoogle Scholar
Brockmeyer DL, York JE, Apfelbaum RI (2000) Anatomical suitability of C1-2 transarticular screw placement in pediatric patients. J Neurosurg 92(1 Suppl):7–11PubMedGoogle Scholar
Crostelli M, Mariani M, Mazzo O et al (2009) Cervical fixation in the pediatric patient: our experience. Eur Spine J 18(Suppl 1):20–28CrossRefGoogle Scholar
Dickman CA, Sonntag VK, Papdopoulos SM et al (1991) The interspinous method of posterior atlantoaxial arthrodesis. J Neurosurg 74(2):190–198CrossRefGoogle Scholar
Haque A, Price AV, Skylar FH et al (2009) Screw fixation of the upper cervical spine in the pediatric population. Clinical article. J Neurosurg Pediatr 3(6):529–533CrossRefGoogle Scholar
Harms J, Melcher RP (2001) Posterior C1-C2 fusion with polyaxial screw and rod fixation. Spine (Phila Pa 1976) 26(22):2467–2471CrossRefGoogle Scholar
Heuer GG, Hardesty DA, Bhowmick DA et al (2009) Treatment of pediatric atlantoaxial instability with traditional and modified Goel-Harms fusion constructs. Eur Spine J 18(6):884–892CrossRefGoogle Scholar
Jeanneret B, Magerl F (1992) Primary posterior fusion C1/2 in odontoid fractures: indications, technique, and results of transarticular screw fixation. J Spinal Disord 5(4):464–475CrossRefGoogle Scholar
Kakarla UK, Chang SW, Theodore N et al (2010) Atlas fractures. Neurosurgery 66(3 Suppl):60–67CrossRefGoogle Scholar
O’Shaughnessy BA, Salehi SA, Ali S et al (2004) Anterior atlas fracture following suboccipital decompression for Chiari I malformation. Report of two cases. J Neurosurg Spine 1(1):137–140CrossRefGoogle Scholar
Rahimi SY, Stevens A, Yeh DJ et al (2003) Treatment of atlantoaxial instability in pediatric patients. Neurosurg Focus 15(6):ECP1CrossRefGoogle Scholar
Wright NM (2005) Translaminar rigid screw fixation of the axis. Technical note. J Neurosurg Spine 3(5):409–414CrossRefGoogle Scholar