C1-C2 FACET SCREWS IN PAEDIATRIC PATIENTS

Abstract

Introduction and Aims: The aim of this paper is to review C1-C2 facet screw use in paediatric patients and to demonstrate that the technique plays an important role in patients with underlying anatomic abnormalities, which are common in children with cervical instability.

Method: A chart review was conducted of all patients managed with C1-C2 facet screws from January 1, 1996 until July 30, 2003 present in the case database. All radiographs were obtained and reviewed. Post-operative and follow-up films were assessed for acceptable screw position and evidence of fusion.

Results: C1-C2 facet screws were utilised in nine patients at British Columbia’s Children’s Hospital. The youngest patient treated was five years of age with a mean age for the group of 12. The group consisted of three Down syndrome patients and six with Os Odontoidium, two of which failed previous C1-C2 fusion. Two patients presented with an acute spinal cord injury. Pre-operative CT or MR imaging was used in all patients.

Screw placement was unacceptable in one case. Post-operative Halo immobilisation was used in seven patients. Post-operative complications included one wound infection and four halo pin infections requiring treatment. No patients have required surgery at a mean follow-up of four years. C1-C2 facet screws are an important adjunct in a paediatric spine practice. This technique has a great advantage in Down syndrome patients who have a high rate of pseudoarthosis because of: ligamentous laxity, non-compliance with immobilisation and a high incidence of congenital deformities such as os odontoidium and incomplete posterior arch of C1.

Conclusion: C1-C2 facet screws can be safely used in young children. The screws allow for fixation in the absence of an intact posterior arch. The technique has a great advantage in Down syndrome patients who have a high rate of pseudoarthosis due to congenital deformities, ligamentous laxity and non-compliance with immobilisation