Feasibility of anterior screw fixation in children: a tomographic study

• Published in: European spine journal Vol. 27; no. 6; pp. 1388 - 1392
• Main Authors: Fernandes, Lívia Gaspar, Cristante, Alexandre Fogaça, Marcon, Raphael Martus, de Barros Filho, Tarcísio Eloy Pessoa, Letaif, Olavo Biraghi
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.06.2018; Springer Nature B.V
• Subjects: Age; Bone implants; Bone Screws; Child; Children; Congenital defects; Feasibility Studies; Female; Fracture Fixation, Internal - instrumentation; Fracture Fixation, Internal - methods; Humans; Male; Medicine; Medicine & Public Health; Neck; Neurosurgery; Nonunion; Odontoid Process - surgery; Original Article; Pain; Spinal Fractures - surgery; Spine; Spine (cervical); Surgical Orthopedics; Trauma; Internal fixation; Children; Computed tomography; Axis; Odontoid process
• ISSN: 0940-6719; 1432-0932
• DOI: 10.1007/s00586-018-5504-5

Purpose Morphology measures of the odontoid process in children under 12 years old were carried out to demonstrate the viability of anterior internal fixation in this population once their active profile may not be compatible with successful conservative treatment. Methods During a 6-month period, 36 tomographic examinations of the cervical spine region that provided visualization of the odontoid process were selected. Group 1 included children between 6 and 9 years of age, and group 2 contained children from 9 to 12 years of age. There were 23 (63.8%) male patients and 13 (36.2%) female patients. Patients diagnosed with a tumor, an infection, fracture non-union, or congenital malformation were excluded. Exams were ordered as part of a protocol applied to non-specific neck pain and pediatric trauma entries. The following parameters were analyzed: (1) screw attack angle, (2) height of the odontoid process, and (3) minimal transverse diameter of the odontoid process. Results In Groups 1 and 2, the average values of the screw attack angle were 55.9° ± 2.3° and 54.8° ± 4.5°, respectively; the average heights of the odontoid process were 26.58 ± 3.28 and 29.48 ± 3 mm, respectively, and the average minimal transverse diameter of the odontoid process were 6.57 ± 1.08 and 6.23 ± 0.88 mm, respectively. The minimal transverse diameter of the odontoid process was statistically higher in males than that in females, regardless of age ( p  = 0.007). Conclusion In both groups, the minimal transverse diameter of the odontoid process allowed for the use of one 3.5–4.5 mm screw for anterior internal fixation. Graphical abstract These slides can be retrieved under Electronic Supplementary Material.