title: The use of inside-outside screws for occipitocervical fusion in pediatric patients.
abstract: OBJECTIVE
  The authors describe the use of inside-outside occipital screws in 21 children with occipitocervical instability requiring occipitocervical fusion.
  
  
  METHODS
  The ages of the patients were from 2 to 15 years, and patients presented with a variety of causes of occipitocervical instability, including congenital disorders, posttraumatic instability, idiopathic degeneration, and postoperative instability. Surgeries frequently included foramen magnum decompression, duraplasty, and laminectomy, but all patients required occipitocervical instrumentation and arthrodesis. Postoperative orthosis included the use of either a cervical collar or halo device. In all but one case, patients were followed postoperatively for at least 12 months.
  
  
  RESULTS
  The mean age of patients was 9.93 years. Inside-outside screws were used in all reported cases. Rib autograft was used in all patients. In addition, demineralized bone matrix was used in 2 cases, and bone morphogenetic protein was used in 2 patients. Two patients required halo placement, and the other 19 were placed in cervical collars. The average time postoperative orthotics were used was 2.82 months. Arthrodesis was determined radiographically and was noted in all patients. No operative complications were noted; however, postoperative complications included 1 wound infection, 2 cases of hardware loosening, and the need for tracheostomy in 2 patients.
  
  
  CONCLUSIONS
  Inside-outside screws were found to be a useful component of occipitocervical instrumentation in pediatric patients ranging from 2 to 15 years of age. Arthrodesis was demonstrated in all cases.
authors.affiliation: Department of Neurosurgery, Emory University Hospital, Atlanta, USA.
authors.forename: Eric Anthony
authors.initials: EA
authors.lastname: Sribnick
authors.forename: Vladamir Y
authors.initials: VY
authors.lastname: Dadashev
authors.forename: Barunashish
authors.initials: B
authors.lastname: Brahma
authors.forename: David M
authors.initials: DM
authors.lastname: Wrubel
mesh_terms: D000293:Adolescent; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007593:Joint Instability / Q000601:surgery*; D008297:Male; D009777:Occipital Bone / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000295:instrumentation*