Pediatric occipital condyle morphometric analysis using computed tomography with evaluation for occipital condyle screw placement

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Occipitocervical fusions in the pediatric population are rare but can be challenging because of the smaller anatomy. The procedure is even more exacting in patients with prior suboccipital craniectomy. A proposed method for occipitocervical fusion in such patients is the use of occipital condyle screws. There is very limited literature evaluating the pediatric occipital condyle for screw placement. The authors examined the occipital condyle in pediatric patients to determine if there was an age cutoff at which condylar screw placement is contraindicated.


The authors performed a retrospective morphometric analysis of the occipital condyle in 518 pediatric patients aged 1 week–9 years old. Patients in their first decade of life whose occipital condyle was demonstrated on CT imaging in the period from 2009 to 2013 at the Augusta University Medical Center and Children’s Hospital of Georgia were eligible for inclusion in this study. Exclusion criteria were an age older than 10 years; traumatic, inflammatory, congenital, or neoplastic lesions of the occipital condyles; and any previous surgery of the occipitocervical junction. Descriptive statistical analysis was performed including calculation of the mean, standard deviation, and confidence intervals for all measurements. Probability values were calculated using the Student t-test with statistical significance determined by p < 0.05.


Overall, male patients had statistically significantly larger occipital condyles than the female patients, but this difference was not clinically significant. There was no significant difference in left versus right occipital condyles. There were statistically significant differences between age groups with a general trend toward older children having larger occipital condyles. Overall, 20.65% of all patients evaluated had at least one measurement that would prevent occipital condyle screw placement including at least one patient in every age group.


Occipital condyle screw fixation is feasible in pediatric patients younger than 10 years. More importantly, all pediatric patients should undergo critical evaluation of the occipital condyle in the axial, sagittal, and coronal planes preoperatively to determine individual suitability for occipital condyle screw placement.

Article Information

Correspondence Khoi Nguyen: Augusta University Medical Center, Augusta, GA.

INCLUDE WHEN CITING Published online March 1, 2019; DOI: 10.3171/2019.1.PEDS18583.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    A: Sagittal view, condylar length measured using the longest axis in the anteroposterior plane. B: Axial view, condylar width measured perpendicular to the midpoint of the long axis. C: Coronal view, condylar height measured perpendicular from the hypoglossal canal to the inferior edge of the condyle. D: Axial view, projected screw length and angle measurements. Figure is available in color online only.





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