title: Rigid variety occiput/C1-C2-C3 internal fixation in pediatric population.
abstract: OBJECTIVE
  The purpose of this study was to review our experience of rigid internal fixation of craniovertebral junction in pediatric population. A new technique of reduction of basilar invagination with atlantoaxial dislocation is described. To the best of our knowledge and available scientific literature, this technique has not yet been described in younger patients.
  
  
  METHODS
  We have managed 27 children by rigid variety of occiput/C1-C2-C3 internal fixation of various craniovertebral junction pathologies. All patients were subjected to thin cuts of computed tomography with 3D reconstruction for selecting appropriate rigid construct. Eight children had occiput-C2, 3 had occiput-C2-C3, and 16 had C1-C2 hardware constuct. One patient of C1-C2-plate fixation had section of C2 nerve root ganglia. Basilar invagination with atlantoaxial dislocation was reduced by new distraction/compression techniques.
  
  
  RESULTS
  Improvement in clinical features and correction of deformity with solid hardware construct were seen in all patients. Follow-up period ranged from 5-72 months. One patient was lost to follow-up, and one case died of compression of vertebral artery at C1 lateral mass. Patients of myelopathy had recovery rate of 90.9%. Hardware failure was seen in one patient, and wound infection was observed in two cases.
  
  
  CONCLUSIONS
  Rigid variety of occiput/C1-C2 internal fixation is a safe and effective method in the management of variety of craniovertebral pathologies in pediatric population. This new technique of reduction of basilar invagination with atlantoaxilal dislocation from posterior approach may alleviate the need of high morbity associated with surgical procedure like transoral odontoidectomy in younger patients.
authors.affiliation: Department of Neurosurgery, G.B. Pant Hospital and Associated Maulana Azad Medical College (University of Delhi), New Delhi, 110002, India, drsanjivsinha@gmail.com.
authors.forename: Sanjiv
authors.initials: S
authors.lastname: Sinha
authors.forename: Anita
authors.initials: A
authors.lastname: Jagetia
authors.forename: Aher Rajendra
authors.initials: AR
authors.lastname: Bhausaheb
authors.forename: Manojkumar V
authors.initials: MV
authors.lastname: Butte
authors.forename: Rahul
authors.initials: R
authors.lastname: Jain
mesh_terms: D000293:Adolescent; D001268:Atlanto-Axial Joint / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D001269:Atlanto-Occipital Joint / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D001863:Bone Screws; D002574:Cervical Vertebrae / Q000002:abnormalities / Q000293:injuries / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000295:instrumentation* / Q000379:methods
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