{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T20:47:34Z","timestamp":1785444454386,"version":"3.56.0"},"reference-count":30,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Surgical fixation for occipitocervical instability can be challenging due to limitations in occipital instrumentation that include prominent hardware, limited fixation points on the occiput, and the risk of intracranial injury. Occipital instrumentation is particularly difficult in pediatric patients with thinner skull osteology and smaller bony surface area. Transarticular atlantooccipital and occipital condyle screw placement are newer techniques that have been described as alternative strategies for occipitocervical fixation. Cadaveric studies have demonstrated the feasibility and biomechanical equivalence to traditional plating systems for both techniques, however their clinical application has been limited. The authors present the largest case series of pediatric patients who underwent either transarticular atlantooccipital or direct occipital condyle screw fixation for the treatment of occipital cervical instability. The authors report their early postoperative outcomes, fusion rates, and feasibility of the surgical procedure in pediatric patients.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n Three patients underwent transarticular atlantooccipital screw fixation, and 3 patients underwent direct occipital condyle screw fixation. Clinical presentation, complications, fusion rates, and postoperative outcomes were reviewed.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n The age range was 2 to 20 years old. Occipitocervical instability was secondary to congenital skeletal dysplasia and neuromuscular scoliosis. Presenting symptoms included dysphagia, dysphonia, headaches, and neck pain. All patients underwent instrumentation guided by neuronavigation. There were no intra- or postoperative complications, and all patients demonstrated evidence of fusion with an average (range) follow-up of 24.1 (15\u201336) months. The authors observed an excellent fusion rate with low morbidity.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSION<\/jats:title>\n Transarticular atlantooccipital and direct occipital condyle screw fixation are alternative techniques to occipital plate fixation. These novel techniques can be performed safely in pediatric patients and provide adequate fixation for successful arthrodesis.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2025.4.peds24670","type":"journal-article","created":{"date-parts":[[2025,7,26]],"date-time":"2025-07-26T01:54:04Z","timestamp":1753494844000},"page":"501-508","source":"Crossref","is-referenced-by-count":1,"title":["Transarticular atlantooccipital and condylar screw fixation with neuronavigation for occipital cervical stabilization in pediatric patients: a case series"],"prefix":"10.3171","volume":"36","author":[{"given":"Hudin N.","family":"Jackson","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Snyder","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Baylor College of Medicine, Houston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David F.","family":"Bauer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Texas Children\u2019s Hospital, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"J Spinal Disord Tech","first-page":"232","article-title":"Occipitocervical fusion via occipital condylar fixation: a clinical case series","volume":"27","author":"Ahmadian A","year":"2014","unstructured":"Ahmadian A, Dakwar E, Vale FL, Uribe JS. Occipitocervical fusion via occipital condylar fixation: a clinical case series. J Spinal Disord Tech. 2014;27(4):232\u2013236."},{"issue":"2","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"171","article-title":"Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation: Case report","volume":"6","author":"Bekelis K","year":"2010","unstructured":"Bekelis K, Duhaime AC, Missios S, Belden C, Simmons N. Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation: Case report. J Neurosurg Pediatr. 2010;6(2):171\u2013176."},{"issue":"8","key":"b3","series-title":"J Spinal Disord Tech","first-page":"540","article-title":"Feasibility of occipital condyle screw placement for occipitocervical fixation: a cadaveric study and description of a novel technique","volume":"21","author":"Uribe JS","year":"2008","unstructured":"Uribe JS, Ramos E, Vale F. Feasibility of occipital condyle screw placement for occipitocervical fixation: a cadaveric study and description of a novel technique. J Spinal Disord Tech. 2008;21(8):540\u2013546."},{"issue":"5","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"634","article-title":"Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement","volume":"23","author":"Viers AG","year":"2019","unstructured":"Viers AG, Nguyen KD, Moon PX, Forseen SE, Heger IM. Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement. J Neurosurg Pediatr. 2019;23(5):634\u2013638."},{"key":"b5","first-page":"543","article-title":"Occipital condyle screw fixation after posterior decompression for Chiari malformation: Technical report and application. Surg Neurol Int","volume":"12","author":"Chakraborty AR","year":"2021","unstructured":"Chakraborty AR, Pelargos PE, Milton CK, Martin MD, Bauer AM, Dunn IF. Occipital condyle screw fixation after posterior decompression for Chiari malformation: Technical report and application. Surg Neurol Int. 2021;12:543."},{"issue":"17","key":"b6","first-page":"E1010","article-title":"Anterior atlantooccipital transarticular screw fixation: a cadaveric study and description of a novel technique. Spine (Phila Pa 1976)","volume":"44","author":"Ji W","year":"2019","unstructured":"Ji W, Xu X, Liu Q, Anterior atlantooccipital transarticular screw fixation: a cadaveric study and description of a novel technique. Spine (Phila Pa 1976). 2019;44(17):E1010\u2013E1017."},{"issue":"12","key":"b7","first-page":"E696","article-title":"Biomechanical comparison of occiput-C1\u2013C2 fixation techniques: C0\u2013C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976)","volume":"37","author":"Takigawa T","year":"2012","unstructured":"Takigawa T, Simon P, Or\u00edas AAE, Biomechanical comparison of occiput-C1\u2013C2 fixation techniques: C0\u2013C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976). 2012;37(12):E696\u2013E701."},{"issue":"6","key":"b8","series-title":"Neurosurgery","first-page":"E1216","article-title":"Occipital cervical stabilization using occipital condyles for cranial fixation: technical case report","volume":"65","author":"Uribe JS","year":"2009","unstructured":"Uribe JS, Ramos E, Baaj A, Youssef AS, Vale FL. Occipital cervical stabilization using occipital condyles for cranial fixation: technical case report. Neurosurgery. 2009;65(6):E1216\u2013E1217."},{"issue":"3","key":"b9","first-page":"E147","article-title":"Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement. Spine (Phila Pa 1976)","volume":"39","author":"Lin SL","year":"2014","unstructured":"Lin SL, Xia DD, Chen W, Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement. Spine (Phila Pa 1976). 2014;39(3):E147\u2013E152."},{"issue":"2","key":"b10","series-title":"J Neurosurg Spine","first-page":"143","article-title":"Biomechanical comparison of occipitoatlantal screw fixation techniques: Laboratory investigation","volume":"8","author":"Bambakidis NC","year":"2008","unstructured":"Bambakidis NC, Feiz-Erfan I, Horn EM, Biomechanical comparison of occipitoatlantal screw fixation techniques: Laboratory investigation. J Neurosurg Spine. 2008;8(2):143\u2013152."},{"issue":"2 Suppl","key":"b11","series-title":"J Neurosurg","first-page":"202","article-title":"Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique","volume":"98","author":"Gonzalez LF","year":"2003","unstructured":"Gonzalez LF, Crawford NR, Chamberlain RH, Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique. J Neurosurg. 2003;98(2 Suppl):202\u2013209."},{"issue":"6","key":"b12","first-page":"703","article-title":"Transarticular screw fixation for atlanto-occipital dislocation. Spine (Phila Pa 1976)","volume":"26","author":"Grob D","year":"2001","unstructured":"Grob D. Transarticular screw fixation for atlanto-occipital dislocation. Spine (Phila Pa 1976). 2001;26(6):703\u2013707."},{"issue":"4","key":"b13","series-title":"J Neurosurg Spine","first-page":"318","article-title":"Use of dual transarticular screws to fixate simultaneous occipitoatlantal and atlantoaxial dislocations: Case report","volume":"3","author":"Gonzalez LF","year":"2005","unstructured":"Gonzalez LF, Klopfenstein JD, Crawford NR, Dickman CA, Sonntag VKH. Use of dual transarticular screws to fixate simultaneous occipitoatlantal and atlantoaxial dislocations: Case report. J Neurosurg Spine. 2005;3(4):318\u2013323."},{"issue":"16","key":"b14","first-page":"1562","article-title":"Optimal trajectory for the atlantooccipital transarticular screw. Spine (Phila Pa 1976)","volume":"35","author":"Lee KM","year":"2010","unstructured":"Lee KM, Yeom JS, Lee JO, Optimal trajectory for the atlantooccipital transarticular screw. Spine (Phila Pa 1976). 2010;35(16):1562\u20131570."},{"issue":"3","key":"b15","series-title":"Spine J","first-page":"245","article-title":"Biomechanical analysis of occipitocervical stability afforded by three fixation techniques","volume":"11","author":"Helgeson MD","year":"2011","unstructured":"Helgeson MD, Lehman RA Jr, Sasso RC, Dmitriev AE, Mack AW, Riew KD. Biomechanical analysis of occipitocervical stability afforded by three fixation techniques. Spine J. 2011;11(3):245\u2013250."},{"issue":"4","key":"b1","series-title":"J Spinal Disord Tech","first-page":"232","article-title":"Occipitocervical fusion via occipital condylar fixation: a clinical case series","volume":"27","author":"Ahmadian A","year":"2014","unstructured":"Ahmadian A, Dakwar E, Vale FL, Uribe JS. Occipitocervical fusion via occipital condylar fixation: a clinical case series. J Spinal Disord Tech. 2014;27(4):232\u2013236."},{"issue":"2","key":"b2","series-title":"J Neurosurg Pediatr","first-page":"171","article-title":"Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation: Case report","volume":"6","author":"Bekelis K","year":"2010","unstructured":"Bekelis K, Duhaime AC, Missios S, Belden C, Simmons N. Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation: Case report. J Neurosurg Pediatr. 2010;6(2):171\u2013176."},{"issue":"8","key":"b3","series-title":"J Spinal Disord Tech","first-page":"540","article-title":"Feasibility of occipital condyle screw placement for occipitocervical fixation: a cadaveric study and description of a novel technique","volume":"21","author":"Uribe JS","year":"2008","unstructured":"Uribe JS, Ramos E, Vale F. Feasibility of occipital condyle screw placement for occipitocervical fixation: a cadaveric study and description of a novel technique. J Spinal Disord Tech. 2008;21(8):540\u2013546."},{"issue":"5","key":"b4","series-title":"J Neurosurg Pediatr","first-page":"634","article-title":"Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement","volume":"23","author":"Viers AG","year":"2019","unstructured":"Viers AG, Nguyen KD, Moon PX, Forseen SE, Heger IM. Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement. J Neurosurg Pediatr. 2019;23(5):634\u2013638."},{"key":"b5","first-page":"543","article-title":"Occipital condyle screw fixation after posterior decompression for Chiari malformation: Technical report and application. Surg Neurol Int","volume":"12","author":"Chakraborty AR","year":"2021","unstructured":"Chakraborty AR, Pelargos PE, Milton CK, Martin MD, Bauer AM, Dunn IF. Occipital condyle screw fixation after posterior decompression for Chiari malformation: Technical report and application. Surg Neurol Int. 2021;12:543."},{"issue":"17","key":"b6","first-page":"E1010","article-title":"Anterior atlantooccipital transarticular screw fixation: a cadaveric study and description of a novel technique. Spine (Phila Pa 1976)","volume":"44","author":"Ji W","year":"2019","unstructured":"Ji W, Xu X, Liu Q, Anterior atlantooccipital transarticular screw fixation: a cadaveric study and description of a novel technique. Spine (Phila Pa 1976). 2019;44(17):E1010\u2013E1017."},{"issue":"12","key":"b7","first-page":"E696","article-title":"Biomechanical comparison of occiput-C1\u2013C2 fixation techniques: C0\u2013C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976)","volume":"37","author":"Takigawa T","year":"2012","unstructured":"Takigawa T, Simon P, Or\u00edas AAE, Biomechanical comparison of occiput-C1\u2013C2 fixation techniques: C0\u2013C1 transarticular screw and direct occiput condyle screw. Spine (Phila Pa 1976). 2012;37(12):E696\u2013E701."},{"issue":"6","key":"b8","series-title":"Neurosurgery","first-page":"E1216","article-title":"Occipital cervical stabilization using occipital condyles for cranial fixation: technical case report","volume":"65","author":"Uribe JS","year":"2009","unstructured":"Uribe JS, Ramos E, Baaj A, Youssef AS, Vale FL. Occipital cervical stabilization using occipital condyles for cranial fixation: technical case report. Neurosurgery. 2009;65(6):E1216\u2013E1217."},{"issue":"3","key":"b9","first-page":"E147","article-title":"Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement. Spine (Phila Pa 1976)","volume":"39","author":"Lin SL","year":"2014","unstructured":"Lin SL, Xia DD, Chen W, Computed tomographic morphometric analysis of the pediatric occipital condyle for occipital condyle screw placement. Spine (Phila Pa 1976). 2014;39(3):E147\u2013E152."},{"issue":"2","key":"b10","series-title":"J Neurosurg Spine","first-page":"143","article-title":"Biomechanical comparison of occipitoatlantal screw fixation techniques: Laboratory investigation","volume":"8","author":"Bambakidis NC","year":"2008","unstructured":"Bambakidis NC, Feiz-Erfan I, Horn EM, Biomechanical comparison of occipitoatlantal screw fixation techniques: Laboratory investigation. J Neurosurg Spine. 2008;8(2):143\u2013152."},{"issue":"2 Suppl","key":"b11","series-title":"J Neurosurg","first-page":"202","article-title":"Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique","volume":"98","author":"Gonzalez LF","year":"2003","unstructured":"Gonzalez LF, Crawford NR, Chamberlain RH, Craniovertebral junction fixation with transarticular screws: biomechanical analysis of a novel technique. J Neurosurg. 2003;98(2 Suppl):202\u2013209."},{"issue":"6","key":"b12","first-page":"703","article-title":"Transarticular screw fixation for atlanto-occipital dislocation. Spine (Phila Pa 1976)","volume":"26","author":"Grob D","year":"2001","unstructured":"Grob D. Transarticular screw fixation for atlanto-occipital dislocation. Spine (Phila Pa 1976). 2001;26(6):703\u2013707."},{"issue":"4","key":"b13","series-title":"J Neurosurg Spine","first-page":"318","article-title":"Use of dual transarticular screws to fixate simultaneous occipitoatlantal and atlantoaxial dislocations: Case report","volume":"3","author":"Gonzalez LF","year":"2005","unstructured":"Gonzalez LF, Klopfenstein JD, Crawford NR, Dickman CA, Sonntag VKH. Use of dual transarticular screws to fixate simultaneous occipitoatlantal and atlantoaxial dislocations: Case report. J Neurosurg Spine. 2005;3(4):318\u2013323."},{"issue":"16","key":"b14","first-page":"1562","article-title":"Optimal trajectory for the atlantooccipital transarticular screw. Spine (Phila Pa 1976)","volume":"35","author":"Lee KM","year":"2010","unstructured":"Lee KM, Yeom JS, Lee JO, Optimal trajectory for the atlantooccipital transarticular screw. Spine (Phila Pa 1976). 2010;35(16):1562\u20131570."},{"issue":"3","key":"b15","series-title":"Spine J","first-page":"245","article-title":"Biomechanical analysis of occipitocervical stability afforded by three fixation techniques","volume":"11","author":"Helgeson MD","year":"2011","unstructured":"Helgeson MD, Lehman RA Jr, Sasso RC, Dmitriev AE, Mack AW, Riew KD. Biomechanical analysis of occipitocervical stability afforded by three fixation techniques. Spine J. 2011;11(3):245\u2013250."}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/4\/article-p501.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/4\/article-p501.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/36\/4\/article-p501.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T13:46:43Z","timestamp":1772804803000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/36\/4\/article-p501.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":30,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2025.4.peds24670","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}