{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T17:16:16Z","timestamp":1763140576243},"reference-count":20,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2012,6]]},"abstract":"\nObject<\/jats:title>\nThe treatment of craniocervical instability in children is often challenging due to their small spine bones, complex anatomy, and unique syndromes. The authors discuss their surgical experience with 33 cases in the treatment of 31 children (\u226417 years of age) with craniocervical spine instability using smaller nontraditional titanium screws and plates, as well as intraoperative CT.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nAll craniocervical fusion procedures were performed using intraoperative fluoroscopic imaging and electrophysiological monitoring. Nontraditional spine hardware included smaller screw sizes (2.4 and 2.7 mm) from the orthopedic hand\/foot set and mandibular plates. Twenty-three of the 33 surgical procedures were performed with intraoperative CT, which was used to confirm adequate position of the spine hardware and alignment of the spine.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nThe mean patient age was 9.5 years (range 2\u201317 years). Eleven children underwent a posterior C1\u20132 transarticular screw fusion, 17 had an occipitocervical fusion, and 3 had a posterior subaxial cervical fusion. The follow-up duration ranged from 9 to 72 months (mean 53 months). All children demonstrated successful fusion at their 3-month follow-up visit, except 1 patient whose unilateral C1\u20132 transarticular screw fusion required a repeat surgery before proper fusion was achieved. Of the 47 C1\u20132 transarticular screws that were placed, 13 were 2.4 mm, 15 were 2.7 mm, 7 were 3.5 mm, and 12 were 4.0 mm. Eighteen of the 47 C1\u20132 transarticular screws were suboptimally placed. Eleven of these misplaced screws were removed and redirected within the same operation because these surgeries benefitted from the use of intraoperative CT; 6 of the 7 remaining suboptimally placed screws were left in place because a second surgery for screw replacement was not warranted. The other suboptimally placed C1\u20132 screw was replaced during a repeat operation due to failure of fusion. Use of intraoperative CT was invaluable because it enabled the authors to reposition suboptimal C1\u20132 transarticular screws without necessitating a second operation.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nSuccessful craniocervical fusion procedures were achieved using smaller nontraditional titanium screws and plates. Intraoperative CT was a helpful adjunct for confirming and readjusting the trajectory of the screws prior to leaving the operating room, which decreases overall treatment costs and reduces complications.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.2.peds11329","type":"journal-article","created":{"date-parts":[[2012,6,1]],"date-time":"2012-06-01T14:00:04Z","timestamp":1338559204000},"page":"594-601","source":"Crossref","is-referenced-by-count":15,"title":["Complex pediatric cervical spine surgery using smaller nonspinal screws and plates and intraoperative computed tomography"],"prefix":"10.3171","volume":"9","author":[{"given":"Mahesh","family":"Karandikar","sequence":"first","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sohail K.","family":"Mirza","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Dartmouth Medical School, Hanover, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kit","family":"Song","sequence":"additional","affiliation":[{"name":"Orthopaedic Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tong","family":"Yang","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter F.","family":"Krengel","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Orthopaedic Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin F.","family":"Spratt","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Dartmouth Medical School, Hanover, New Hampshire"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony M.","family":"Avellino","sequence":"additional","affiliation":[{"name":"Departments of Neurological Surgery and"},{"name":"Orthopaedic Surgery, Harborview Medical Center, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington; and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"1 Suppl","key":"b1-0090594","series-title":"J Neurosurg","first-page":"36","article-title":"Selection of a rigid internal fixation construct for stabilization at the craniovertebral junction in pediatric patients","volume":"107","author":"Anderson","year":"2007"},{"key":"b2-0090594","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1159\/000120893","article-title":"Pediatric cervical spine instrumentation using screw fixation","volume":"22","author":"Brockmeyer","year":"1995"},{"issue":"1 Suppl","key":"b3-0090594","series-title":"J Neurosurg","first-page":"7","article-title":"Anatomical suitability of C1-2 transarticular screw placement in pediatric patients","volume":"92","author":"Brockmeyer","year":"2000"},{"key":"b4-0090594","series-title":"Pediatrics","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1542\/peds.2007-1910","article-title":"Radiation risk to children from computed tomography","volume":"120","author":"Brody","year":"2007"},{"key":"b5-0090594","series-title":"J Neurosurg Pediatr","doi-asserted-by":"publisher","first-page":"359","DOI":"10.3171\/PED.2008.2.11.359","article-title":"Failed age-dependent maturation of the occipital condyle in patients with congenital occipitoatlantal instability and Down syndrome: a preliminary analysis. 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