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.	馬維虎, 劉觀燚, 徐榮明, 等. 寰椎椎弓根螺釘及樞椎椎板螺釘固定植骨融合治療創傷性上頸椎不穩. 中國脊柱脊髓雜志, 2010, 20(3):214-218.
9.	劉曉嵐, 周若舟, 劉社庭, 等. 樞椎椎弓峽部引導下寰椎椎弓根置釘的CT測量及其應用. 中國脊柱脊髓雜志, 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. 兒童骨骼損傷. 柳用墨, 譯. 北京:人民衛生出版社, 1987:274-275.
12.	校佰平, 徐榮明. 寰樞椎經椎弓根螺釘固定技術的臨床應用. 中國脊柱脊髓雜志, 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, 鄒鴻星, 楊淮河, 等. 寰樞椎椎弓根釘棒內固定治療創傷后寰樞椎不穩. 江西醫藥, 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, 劉夏君, 王新虎, 等. 經后路寰樞椎椎弓根螺釘固定融合術治療寰樞椎失穩. 中國骨傷, 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, 徐榮明, 馬維虎, 等. 不穩性寰椎骨折的外科治療策略. 中國創傷雜志, 2011, 27(2):115-120.
19.	賈連順, 袁文. 頸椎外科學. 北京:人民衛生出版社, 2009:268.
20.	馬向陽, 鐘世鎮, 劉景發, 等. 寰椎椎弓根螺釘進釘點的解剖定位研究. 骨與關節損傷雜志, 2003, 18(10):683-685.
21.	譚明生, 唐向盛, 移平, 等. 寰椎椎弓根顯露置釘法的臨床應用. 脊柱外科雜志, 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.	譚明生, 唐向盛, 王文軍, 等. 寰樞椎椎弓根螺釘內固定術治療兒童寰樞椎脫位的初步報告. 中國脊柱脊髓雜志, 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. 馬維虎, 劉觀燚, 徐榮明, 等. 寰椎椎弓根螺釘及樞椎椎板螺釘固定植骨融合治療創傷性上頸椎不穩. 中國脊柱脊髓雜志, 2010, 20(3):214-218.
9. 劉曉嵐, 周若舟, 劉社庭, 等. 樞椎椎弓峽部引導下寰椎椎弓根置釘的CT測量及其應用. 中國脊柱脊髓雜志, 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. 兒童骨骼損傷. 柳用墨, 譯. 北京:人民衛生出版社, 1987:274-275.
12. 校佰平, 徐榮明. 寰樞椎經椎弓根螺釘固定技術的臨床應用. 中國脊柱脊髓雜志, 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, 鄒鴻星, 楊淮河, 等. 寰樞椎椎弓根釘棒內固定治療創傷后寰樞椎不穩. 江西醫藥, 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, 劉夏君, 王新虎, 等. 經后路寰樞椎椎弓根螺釘固定融合術治療寰樞椎失穩. 中國骨傷, 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, 徐榮明, 馬維虎, 等. 不穩性寰椎骨折的外科治療策略. 中國創傷雜志, 2011, 27(2):115-120.
19. 賈連順, 袁文. 頸椎外科學. 北京:人民衛生出版社, 2009:268.
20. 馬向陽, 鐘世鎮, 劉景發, 等. 寰椎椎弓根螺釘進釘點的解剖定位研究. 骨與關節損傷雜志, 2003, 18(10):683-685.
21. 譚明生, 唐向盛, 移平, 等. 寰椎椎弓根顯露置釘法的臨床應用. 脊柱外科雜志, 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. 譚明生, 唐向盛, 王文軍, 等. 寰樞椎椎弓根螺釘內固定術治療兒童寰樞椎脫位的初步報告. 中國脊柱脊髓雜志, 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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