Rigid Fixation Improves Outcomes of Spinal Fusion for C1-C2 Instability in Children with Skeletal Dysplasias

by Ilkka Helenius, Haemish Crawford, Paul D. Sponseller, Thierry Odent, Robert M. Bernstein, Anthony A. Stans, Daniel Hedequist, and Jonathan H. Phillips

J Bone Joint Surg AmVolume 97(3):232-240

February 4, 2015

©2015 by The Journal of Bone and Joint Surgery, Inc.

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.

Preoperative sagittal flexion (Fig. 1-A) and extension (Fig. 1-B) MRIs show a dysmorphic dens with C1-C2 instability and canal encroachment.

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.

Four-year lateral flexion radiograph shows nonunion and cable breakage.

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.

Radiograph made two years after revision surgery showing occiput-C5 instrumentation with rib autograft and solid fusion.

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.

Preoperative sagittal flexion (Fig. 2-A) and extension (Fig. 2-B) MRIs showing os odontoideum and translational movement between C1 and C2, demonstrating C1-C2 instability.

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.

Two-year lateral follow-up radiograph showing solid fusion after C1-C2 instrumentation (Harms technique).

Ilkka Helenius et al. J Bone Joint Surg Am 2015;97:232-240

©2015 by The Journal of Bone and Joint Surgery, Inc.