Translaminar screw fixation in the subaxial pediatric cervical spine

Technical note

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The use of spinal instrumentation to stabilize the occipitocervical junction in pediatric patients has increased and evolved in recent years. Wiring techniques have now given way to screw-rod or screw-plate techniques with or without postoperative external immobilization. Although C-2 translaminar screws have been used in these constructs, subaxial translaminar screws have not, to date, been described in either the pediatric or adult patient populations.

The authors describe the feasibility of translaminar screw placement in the C-3 lamina. Rigid fixation with translaminar screws offers an alternative to subaxial fixation with lateral mass screws, allowing for formation of biomechanically sound spinal constructs and minimizing potential neurovascular morbidity. Their use requires careful analysis of preoperative imaging studies, intact posterior elements, and avoidance of violation of the inner laminar wall.

Abbreviation used in this paper: ADI = atlantodental interval.

Article Information

Address correspondence to: Andrew Jea, M.D., Texas Children's Hospital, CCC 1230.01, 12th Floor, Houston, Texas 77030. email:

© AANS, except where prohibited by US copyright law.



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    Cervical flexion (A) and extension (B) radiographs showing that with hyperextension there is ~ 50° of lordotic angulation and ~ 30% retrolisthesis at the C6–7 level. The anterior ADI measures ~ 7.2 mm. With flexion, the anterior ADI measures 8.9 mm.

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    Midsagittal reconstruction of cervical spine CT scan showing an increased ADI and os odontoideum.

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    Sagittal T2-weighted MR image showing spinal cord compression at the cervicomedullary junction with cord signal change.

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    Postoperative axial CT scan at the level of C-3 showing intralaminar placement of a 3.5 × 20–mm screw.

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    Postoperative midsagittal CT scan obtained at 3-month follow-up demonstrating osseous fusion between the occiput and C-3.

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    Cervical flexion (A) and extension (B) radiographs obtained 3 months postoperatively showing no instability between C-1 and C-2.



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