The application of C1-C2 pedicle screw internal fixation on the upper cervical diseases of chil-dren

夏 虹(Xia Hong，Dept Orthop，Guangzhou Gen Hosp Guangzhou Mil Command，Guangzhou，Guangdong 510010)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－181～185

The application of C1-C2 pedicle screw internal fixation on the upper cervical diseases of chil-dren

夏 虹(Xia Hong，Dept Orthop，Guangzhou Gen Hosp Guangzhou Mil Command，Guangzhou，Guangdong 510010)…∥Chin J Clin Basic Orthop Res.－2010，2(3).－181～185

ObjectiveTo report five cases of puerile(＜9 years)atlantoaxial instability which underwent C1-C2 pedicle screw internal fixation by posterior approach，and to introduce the surgical technique and the key point of intra-and post-operative management.MethodsThe average age of the five cases(1 male and 4 female)was 77.6 months(2 years to 9 years and 8 months old).All cases had atlantoaxial instability，one with dens tumor，one with atlantoaxial trauma，and three with dysplasia.All of the cases had syndromes of neck pain，limitation of cervical motion，and tetraparesis in different degrees due to the compression of spinal cord.Cervical X-ray including dynamic position，MRI，and three-dimension CT scanning were performed preoperatively.The computer aided design-rapid prototyping(CAD-RP)technique was utilized with the data from the three-dimension CT to create the atlantoaxial and pedicle screw drill models.The screw placement procedure was monitored by fluoroscopy.The case with dens tumor underwent posterior instrumentation followed by transoral tumor resection.ResultsAll of the operations were successful with no complications.The average estimated blood loss was 100 ～ 300 mL.The CT scanning showed the screws were in good position.Follow-up at 3 ～6 months demonstrated all of the patient significant recovery and no complication happened.ConclusionThe technique of pedicle screw internal fixation with 3.5 mm screw could be applied to the atlantoaxial instability of children.With the help of C-arm，3D CAD and drill guide models，the anchor of the screws would be more accurate.16 refs，2 figs.

(Authors)