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  • Hybrid Lateral Mass Screw Sublaminar Wire Construct: A Salvage Technique for Posterior Cervical Fixation in Pediatric Spine Surgery

    Final Number:
    1505

    Authors:
    John C Quinn MD; Nitesh Vijay Patel MD; Rachana Tyagi MD

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    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.

    References:

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