Transarticular atlantooccipital and condylar screw fixation with neuronavigation for occipital cervical stabilization in pediatric patients: a case series.

OBJECTIVE: Surgical fixation for occipitocervical instability can be challenging due to limitations in occipital instrumentation that include prominent hardware, limited fixation points on the occiput, and the risk of intracranial injury. Occipital instrumentation is particularly difficult in pediatric patients with thinner skull osteology and smaller bony surface area. Transarticular atlantooccipital and occipital condyle screw placement are newer techniques that have been described as alternative strategies for occipitocervical fixation. Cadaveric studies have demonstrated the feasibility and biomechanical equivalence to traditional plating systems for both techniques, however their clinical application has been limited. The authors present the largest case series of pediatric patients who underwent either transarticular atlantooccipital or direct occipital condyle screw fixation for the treatment of occipital cervical instability. The authors report their early postoperative outcomes, fusion rates, and feasibility of the surgical procedure in pediatric patients.

METHODS: Three patients underwent transarticular atlantooccipital screw fixation, and 3 patients underwent direct occipital condyle screw fixation. Clinical presentation, complications, fusion rates, and postoperative outcomes were reviewed.

RESULTS: The age range was 2 to 20 years old. Occipitocervical instability was secondary to congenital skeletal dysplasia and neuromuscular scoliosis. Presenting symptoms included dysphagia, dysphonia, headaches, and neck pain. All patients underwent instrumentation guided by neuronavigation. There were no intra- or postoperative complications, and all patients demonstrated evidence of fusion with an average (range) follow-up of 24.1 (15-36) months. The authors observed an excellent fusion rate with low morbidity.

CONCLUSION: Transarticular atlantooccipital and direct occipital condyle screw fixation are alternative techniques to occipital plate fixation. These novel techniques can be performed safely in pediatric patients and provide adequate fixation for successful arthrodesis.