• Xiang Guo, Zhao Han, Qunxiang Chen, Jun Yang, Fei Chen, Qunfeng Guo, Peida Lin, and Bin Ni.
• Department of Orthopedics, Changzheng Hospital, The Second Military Medical University, Shanghai, People's Republic of China.
• Spine. 2020 Feb 15; 45 (4): 244-249.

Study DesignA retrospective case series study with at least 10 years of follow-up data.ObjectiveTo validate the reliability of bilateral C1-2 transarticular screws and C1 laminar hooks and a bone autograft for acute pediatric atlantoaxial instability.Summary Of Background DataThe reliability of initial posterior atlantoaxial fusion in pediatric patients is still controversial. To date, however, only a few published articles with short-term follow-up data are available to help spinal surgeons understand the effects of posterior atlantoaxial fusion in the skeletally immature spine.MethodsFive pediatric patients with acute atlantoaxial instability underwent atlantoaxial fusion using the above technique over a 3-year period. During a minimum 10-year follow-up period, not only outcomes and complications were investigated, but the vertical growth of the constructed spine in relation to the growth of the entire cervical spine, overall cervical spinal alignment, and adjacent-segment instability were evaluated.ResultsThe clinical follow-up indicated solid fusion and complete clinical relief from symptoms. No neural or vascular impairment was observed. The radiological evaluation showed that all patients had growth within the fusion construct reaching a mean 35.4% of the entire cervical spine. There were no radiological indicators of subaxial instability, even when cervical sagittal alignments became straight with a mean C2-7 angle of 6.4°.ConclusionThe results showed that initial posterior atlantoaxial fusion accomplished with bilateral C1-2 transarticular screws, C1 laminar hooks fixation, and bony autograft is a reliable surgical technique for treating acute pediatric atlantoaxial instability without negative effects on vertical growth at the fused level or the stability of the subaxial spine.Level Of Evidence3.

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