title: Placement of occipital condyle screws for occipitocervical fixation in a pediatric patient with occipitocervical instability after decompression for Chiari malformation.
abstract: In cadaveric studies and recently in one adult patient the occipital condyle has been studied as an option to allow bone purchase by fixation devices. In the current case the authors describe the use of occipital condyle screws in a child undergoing occipitocervical fixation. To the best of the authors' knowledge this case is the first reported instance of this technique in a pediatric patient. This girl had a history of posterior fossa decompression for Chiari malformation Type I when she was 22 months of age. When she was 6 years old she presented with neck pain on flexion and extension of her head. Magnetic resonance imaging in flexion and extension revealed occipitocervical instability. She underwent an occiput to C-2 posterior arthrodesis with bilateral screw placement in the occipital condyles, C-2 lamina, and C-1 lateral masses. Postoperatively, she was neurologically intact. Computed tomography demonstrated a stable construct, and her cervical pain had resolved on follow-up.
authors.affiliation: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA. kbekelis@gmail.com
authors.forename: Kimon
authors.initials: K
authors.lastname: Bekelis
authors.forename: Ann-Christine
authors.initials: AC
authors.lastname: Duhaime
authors.forename: Symeon
authors.initials: S
authors.lastname: Missios
authors.forename: Clifford
authors.initials: C
authors.lastname: Belden
authors.forename: Nathan
authors.initials: N
authors.lastname: Simmons
mesh_terms: D001139:Arnold-Chiari Malformation / Q000175:diagnosis / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000473:pathology / Q000601:surgery*; D001863:Bone Screws; D016025:Bone Transplantation; D002648:Child; D003399:Craniotomy; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D007593:Joint Instability / Q000175:diagnosis / Q000601:surgery*; D007796:Laminectomy; D008279:Magnetic Resonance Imaging; D009777:Occipital Bone / Q000601:surgery*; D010985:Platybasia / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D014057:Tomography, X-Ray Computed