Introduction: To present a novel salvage technique for pediatric subaxial cervical spine fusion in which lateral mass screw fixation was not possible due to anatomic constraints
Methods: This is a case presentation detailed a 4 year old patient with C5-C6 flexion/distraction injury with bilateral jumped facets. Posterior cervical fixation was attempted; however, lateral mass fracture occurred during placement of screws. Using a wire-screw construct, an attempt was made to provide stable fixation. Patient was followed post-operatively for assessment of outcomes.
Results: After the patient had progressive kyphosis following initial closed reduction and external orthosis, internal reduction with fusion/fixation was performed. Lateral mass fracture occurred during placement of lateral mass screws. After placement of a sub-laminar wire-lateral mass screw construct, intraoperative evaluation determined stability. Post-operatively, the procedure resulted in stable fixation with evidence of bony fusion on follow-up.
Conclusions: Pediatric subaxial cervical spine instrumentation provides rigid fixation however is technically difficult due to anatomic and instrumentation related constraints. In the presented case, the wire-screw construct resulted in stable fixation and bony fusion on follow-up. A modified sublaminar wire-lateral mass screw construct is an example of a salvage technique that provides immediate stability in the event of instrumentation related lateral mass fracture.
Patient Care: Provide a methodology by which lateral mass screw breakthrough can be stabilized in pediatric spine trauma cases and allow for fusion.
Learning Objectives: Lateral mass screw breakthrough can occur in pediatric spine trauma.
Stabilization of lateral mass breakthrough in pediatric spine cases is challenging.
Wire-Screw hybrid fixation techniques can be used as a salvage option for stabilization and can lead to successful fusion.