Skip to main content
SpringerLink
Log in

Wiring or Screwing at the Craniovertebral Junction in Childhood: Past and Present Personal Experience

  • Chapter
  • First Online:
New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

  • 1731 Accesses

Abstract

Background: Craniovertebral junction (CVJ) instrumentation and fusion in childhood are frequently performed with either sublaminar wires or screws in lateral masses, and both are considered quite safe procedures.

Methods: Our experience deals with 12 children: six (mean age 9.5 years) harbouring a congenital instability associated with Down’s or Morquio’s syndromes and primary os odontoideum; and six (mean age 11.5 years) with acquired iatrogenic instability due to transoral anterior decompression for different reasons (inferior clivectomy, anterior arch removal and odontoidectomy). All patients in the ‘congenital group’, except for one, had preoperative dynamic x-rays and underwent surgical correction by means of posterior wiring, fusion and an external orthosis. All patients in the ‘iatrogenic group’ had no preoperative dynamic x-rays and underwent a screwing technique with fusion and an external orthosis.

Results: The postoperative clinical picture had improved in all patients at the latest follow-up (observation range 63–202 months [mean 118.5 months]), with neuroradiological confirmation of satisfactory bony fusion and with neural decompression in all patients.

Conclusion: Although it requires a more accurate preoperative neuroradiological setting, the screwing technique takes less time and is characterized by less blood loss and less postoperative discomfort than the wiring technique. The latter features confirm the simplicity, safety (continuous fluoroscopic assistance is not necessary, and there is no risk of neurovascular injuries) and lower expense (neither complex hardware devices nor neuronavigation systems are required) of the screwing technique.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Visocchi M, Doglietto F, Della Pepa GM, Esposito G, La Rocca G, Di Rocco C, Maira G, Fernandez E. Endoscope-assisted microsurgical transoral approach to the anterior craniovertebral junction compressive pathologies. Eur Spine J. 2011;20:1518–25.

    Article  Google Scholar 

  2. Visocchi M, Della Pepa GM, Doglietto F, Esposito G, La Rocca G, Massimi L. Video-assisted microsurgical transoral approach to the craniovertebral junction: personal experience in childhood. Childs Nerv Syst. 2011;27(5):825–31.

    Article  Google Scholar 

  3. Visocchi M. Advances in videoassisted anterior surgical approach to the craniovertebral junction. Adv Tech Stand Neurosurg. 2011;37:97–110.

    Article  Google Scholar 

  4. Visocchi M. Videoassisted anterior surgical approaches to the craniocervical junction: rationale and clinical results. Eur Spine J. 2014;24:2713–23. https://doi.org/10.1007/s00586-015-3873-6.

    Article  Google Scholar 

  5. Visocchi M, Fernandez EM, Ciampini A, Di Rocco C. Reducible and irreducible os odontoideum treated with posterior wiring, instrumentation and fusion. Past or present? Acta Neuroch (Wien). 2009;151(10):1265–74.

    Article  Google Scholar 

  6. Visocchi M, Di Rocco F, Meglio M. Craniocervical junction instability: instrumentation and fusion with titanium rods and sublaminar wires. Effectiveness and failures in personal experience. Acta Neurochir. 2003;145:265–72.

    Article  CAS  Google Scholar 

  7. Frankel HC, Hancock DO, Hyslop G. The value of postural reduction in the initial management of closed injures of the spine with paraplegia and tetraplegia. Paraplegia. 1969;7:179–1932.

    CAS  PubMed  Google Scholar 

  8. Gluf WM, Brockmeyer DL. Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications and lessons learned in 67 paediatric patients. J Neurosurg Spine. 2005;2:164–9.

    Article  Google Scholar 

  9. Magerl F, Seman PS. Stable posterior fusion of the atlas and axis by transarticular screw fixation. In: Kehr P, editor. Cervical spine. New York: Springer; 1987. p. 322–7.

    Chapter  Google Scholar 

  10. Diaz JH, Belani KG. Perioperative management of children with mucopolysaccharidoses. Anesth Analg. 1993;77:1261–70.

    Article  CAS  Google Scholar 

  11. Lorenzo D. Craniocervical junction malformation treated by transoral approach. A survey of 25 cases with emphasis on postoperative instability and outcome. Acta Neuroch. 1992;118:112–6.

    Article  Google Scholar 

  12. Grob D. Occipitocervical fusion in patients with rheumatoid arthritis. Clin Orthop. 1999;366:46–53.

    Article  Google Scholar 

  13. Grob D, Dvorak J, Panjabi M. Posterior occipitocervical fusion. A preliminary report of a new technique. Spine. 1991;16(3 Suppl):17–24.

    Article  Google Scholar 

  14. Grob D, Dvorak J, Panjabi MM, Antinnes JA. The role of plate and screw fixation in occipitocervical fusion in rheumatoid arthritis. Spine. 1994;15:2545–51.

    Article  Google Scholar 

  15. Hensinger RN. Congenital anomalies of the cervical spine. Clin Orthop. 1991;64:16–38.

    Google Scholar 

  16. Oda I, Abumi K, Sell LC, Haggerty CJ, Cunningham BW, McAfee PC. Biomechanical evaluation of five different occipito-atlanto-axial fixation technique. Spine. 1999;24:2377–82.

    Article  CAS  Google Scholar 

  17. Smith MD, Anderson P, Grady MS. Occipitocervical arthrodesis using contoured plate fixation, an early report on a versatile fixation technique. Spine. 1993;18(14):1984–90.

    Article  CAS  Google Scholar 

  18. Vale E. Rigid occipitocervical fusion. J Neursurg. 1999;91(2 Suppl):144–50.

    CAS  Google Scholar 

  19. Cahill D. Posterior occipital reconstruction using cervical pedicle screw and plate–rod system. Spine 15. 2000;24(14):1425–34.

    Google Scholar 

  20. Grob D, Janneret B, Aebi M. Atlantoaxial fusion with transarticular screw fixation. J Bone Joint Surg. 1991;73B:972–6.

    Article  Google Scholar 

  21. Marcotte P, Dickman CA, Sonntag VHK. Posterior atlantoaxial facet screw fixation. J Neurosurg. 1993;79:234–7.

    Article  CAS  Google Scholar 

  22. Dickman CA. Occipitocervical wiring techniques. In: Surgery of the craniovertebral junction. New York: Thieme; 1998. p. 795–808.

    Google Scholar 

  23. Menezes AH. Occipito-cervical fusion: indications, technique and avoidance of complications. In: Hitchon PW, editor. Techniques of spinal fusion and stabilisation. New York: Thieme; 1994. p. 82–91.

    Google Scholar 

  24. Segal LE, Drummond DS, Zanotti RM. Complications of posterior arthrodesis of the cervical spine in patients who have Down syndrome. J Bone Joint Surg Am. 1991;73:1547–54.

    Article  CAS  Google Scholar 

  25. Ryken TC, Menezes AH. Abnormailities of the craniovertebral junction in Down’s syndrome. In: Principles of spinal surgery. New York: McGraw Hill; 1995. p. 395–409.

    Google Scholar 

  26. Visocchi M, Trevisi G, Iacopino DG, Tamburrini G, Caldarelli M, Barbagallo GM. Odontoid process and clival regeneration with Chiari malformation worsening after transoral decompression: an unexpected and previously unreported cause of “accordion phenomenon”. Eur Spine J. 2015;24(Suppl 4):S564–8.

    Article  Google Scholar 

  27. Visocchi M, Mattogno PP, Signorelli F, Zhong J, Iacopino G, Barbagallo G. Complications in craniovertebral junction instrumentation: hardware removal can be associated with long-lasting stability. Personal experience. Acta Neurochir Suppl. 2017;124:187–94.

    Article  Google Scholar 

Download references

Competing Interests

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Institute of Neurosurgery, Catholic University School of Medicine, Rome, Italy

    Massimiliano Visocchi, Francesco Signorelli, Alessandro Olivi & Massimo Caldarelli

Authors
  1. Massimiliano Visocchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesco Signorelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Olivi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Massimo Caldarelli
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

Ethics declarations

No financial support was received for this work.

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Visocchi, M., Signorelli, F., Olivi, A., Caldarelli, M. (2019). Wiring or Screwing at the Craniovertebral Junction in Childhood: Past and Present Personal Experience. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_36

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-62515-7_36

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62514-0

  • Online ISBN: 978-3-319-62515-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation