Posterior Cervical-Thoracic Spinal Fixation Using Adult Type Mandibular Instrumentation to Treat Acute Cervical Spine Subaxial Traumatic Instability in the Young Pediatric Population

Introduction: Surgical fixation of the pediatric subaxial cervical spine poses significant challenges due to a mismatch between rigid adult cervical spine hardware and the size and shape of bone in a young (below 8 years of age) cervical spine.

Methods: We conducted a retrospective review of our experience with subaxial cervical spine screw fixation using adult type mandibular instrumentation in pediatric patients younger than 8 years, symptomatic from acute traumatic cervical spine injury during the period of 2007 through 2023 at our institution.

Results: We identified 5 patients with the mean age of 4.4 years (range 2-6 years) who all had spinal cord injury with subluxation at C6-7. All patients underwent posterior cervico-thoracic fixation with mandibular fixation from C2 to the upper thoracic spine. All patients’ fusion was successful with only one complication of a right vertebral artery occlusion by screw placement, which did not cause harm. Suboptimal screw placement was detected in 18.4 % of screws, but no revision was needed, since was asymptomatic. All patients fused successfully without significant hardware failure. The mean follow up was 84 months ranging from 15 to 180 months.

Conclusion : Mandibular screw and plate fixation was effective and safe to treat acutely unstable subaxial cervical spine traumatic subluxation in the young pediatric population. The rate of suboptimal screw placement may be reduced by placing shorter screws into the lamina directly if the plate hole does not align well enough for a standard trajectory needed for lateral mass or pedicle screw placement.