• Alexandre Fogaça Cristante, Alessandro Gonzalez Torelli, Rafael Bellucci Kohlmann, Ivan Dias da Rocha, Olavo Letaif Biraghi, Alexandre Sadao Iutaka, Raphael Martus Marcon, Reginaldo Perilo Oliveira, and Tarcísio Eloy Pessoa de Barros Filho.
• Spine Division, Orthopaedics and Traumatology Institute, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil. aacristante@uol.com.br
• Neurosurgery. 2012 Apr 1;70(4):835-8; discussion 838-9.

BackgroundThere are several techniques for screw insertion in upper cervical spine surgery, and the use of the 3.5-mm screw is usually the standard. However, there is no consensus regarding the feasibility of using these screws in the pediatric population.ObjectiveTo determine the measurement of the lamina angle, lamina and pedicle length and thickness, and lateral mass length of the topographic axial view of the axis vertebra of 2- to 10-year-old children to guide the use of surgical screws.MethodsSeventy-five computed tomography scans from 24- to 120-month-old patients were studied. Measurements were taken in an axial view of C2 and correlated with 2 age groups and both sexes. Statistical analysis was performed with the Student t test.ResultsIn the 24- to 48-month age group, only 5.5% of the lamina and 8.3% of the pedicles had thicknesses < 3.5 mm. In the 49- to 120-month age group, there were no lamina thickness values < 3.5 mm, and 1.2% of pedicle thicknesses were < 3.5 mm. Both age groups had no lamina and pedicle lengths < 12 mm and no lateral mass lengths > 12 mm.ConclusionIn the majority of cases, the use of 3.5-mm lamina and pedicle screws in children is feasible. A base value of 45° for the spinolaminar angle can be adopted as a reference for insertion of screws in the C2 lamina. This information can be particularly useful for decision making during preoperative planning for C1-C2 or craniocervical arthrodesis in children.

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