title: Hybrid lateral mass screw sublaminar wire construct: A salvage technique for posterior cervical fixation in pediatric spine surgery.
abstract: We present a novel salvage technique for pediatric subaxial cervical spine fusion in which lateral mass screw fixation was not possible due to anatomic constraints. The case presentation details a 4-year-old patient with C5-C6 flexion/distraction injury with bilateral jumped facets. Posterior cervical fixation was attempted; however, lateral mass fracture occurred during placement of screws. Using a wire-screw construct, an attempt was made to provide stable fixation. The patient was followed post-operatively for assessment of outcomes. After the patient had progressive kyphosis following initial closed reduction and external orthosis, internal reduction with fusion/fixation was performed. Lateral mass fracture occurred during placement of lateral mass screws. After placement of a sub-laminar wire-lateral mass screw construct, intra-operative evaluation determined stability. Post-operatively, the procedure resulted in stable fixation with evidence of bony fusion on follow-up. Pediatric subaxial cervical spine instrumentation provides rigid fixation however is technically difficult due to anatomic and instrumentation related constraints. In the presented patient, the wire-screw construct resulted in stable fixation and bony fusion on follow-up. A modified sublaminar wire-lateral mass screw construct is an example of a salvage technique that provides immediate stability in the event of instrumentation related lateral mass fracture.
authors.affiliation: Department of Neurological Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Quinn
authors.affiliation: Department of Neurological Surgery, Rutgers, New Jersey Medical School, Newark, NJ, USA; Division of Neurosurgery, Rutgers, Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2100, New Brunswick, NJ 08901, USA. Electronic address: patel236@njms.rutgers.edu.
authors.forename: Nitesh V
authors.initials: NV
authors.lastname: Patel
authors.affiliation: Division of Neurosurgery, Rutgers, Robert Wood Johnson Medical School, 125 Paterson Street, Suite 2100, New Brunswick, NJ 08901, USA.
authors.forename: Rachana
authors.initials: R
authors.lastname: Tyagi
mesh_terms: D001863:Bone Screws; D002574:Cervical Vertebrae / Q000601:surgery; D002648:Child; D005260:Female; D050723:Fractures, Bone / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D007738:Kyphosis / Q000209:etiology / Q000601:surgery; D008297:Male; D012086:Reoperation / Q000295:instrumentation / Q000379:methods; D016879:Salvage Therapy; D013123:Spinal Fusion / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*
keywords: Cervical spine fixation; Lateral mass screws; Pediatric cervical spine