Introduction: Upper cervical spine stabilization in children can be challenging due to anatomic abnormalities. Many authors have shown C1 lateral mass screws to be safe and effective in adults; however, no large series has been reported in the pediatric literature.
Objectives: The purpose of this study was to describe the indications, technique, and outcomes of C1 lateral mass screw fixation in a consecutive series of 11 paediatric patients.
Materials and Methods: A retrospective chart review of all patients who underwent C1 lateral mass screw fixation as part of an upper cervical spine stabilization construct was performed. Patient demographics and clinical outcomes were recorded. Radiographs immediately post-operatively, at six-weeks, three-months, and final follow-up were reviewed.
Results: Eleven consecutive patients underwent bilateral C1 lateral mass screw fixation for various conditions. The average age was 10 years (range 4–16 years) with a mean follow-up of 11 months (range 6–18 months). There were no iatrogenic vertebral artery, hypoglossal nerve or spinal cord injuries. All patients had solid fusion clinically and radiographically, with no loss of fixation. The C2 dorsal root ganglion was sacrificed in all patients with resulting minor occipital parasthaesia that progressively diminished in severity.
Conclusion and Significance: C1 lateral mass screws offer significant advantages over traditional fixation techniques when the C1 vertebra is included in an upper cervical instrumented construct. This is the largest series of consecutive patients reported in the literature to date showing that the technique is safe and effective, with acceptable morbidity when applied to the paediatric population.