Equivalence of fusion rates after rigid internal fixation of the occiput to C-2 with or without C-1 instrumentation: Clinical article

Todd C. Hankinson, Anthony M. Avellino, David Harter, Andrew Jea, Sean Lew, David Pincus, Mark R. Proctor, Luis Rodriguez, David Sacco, Theodore Spinks, Douglas L. Brockmeyer, Richard C.E. Anderson

Research output: Contribution to journalArticlepeer-review

36 Scopus citations


Object. The object of this study was to assess a multiinstitutional experience with pediatric occipitocervical constructs to determine whether a difference exists between the fusion and complication rates of constructs with or without direct C-1 instrumentation. Methods. Seventy-seven cases of occiput-C2 instrumentation and fusion, performed at 9 children's hospitals, were retrospectively analyzed. Entry criteria included atlantooccipital instability with or without atlantoaxial instability. Any case involving subaxial instability was excluded. Constructs were divided into 3 groups based on the characteristics of the anchoring spinal instrumentation: Group 1, C-2 instrumentation; Group 2, C-1 and C-2 instrumentation without transarticular screw (TAS) placement; and Group 3, any TAS placement. Groups were compared based on rates of fusion and perioperative complications. Results. Group 1 consisted of 16 patients (20.8%) and had a 100% rate of radiographically demonstrated fusion. Group 2 included 22 patients (28.6%), and a 100% fusion rate was achieved, although 2 cases were lost to follow-up before documented fusion. Group 3 included 39 patients (50.6%) and demonstrated a 100% radiographic fusion rate. Complication rates were 12.5, 13.7, and 5.1%, respectively. There were 3 vertebral artery injuries, 1 (4.5%) in Group 2 and 2 (5.1%) in Group 3. Conclusions. High fusion rates and low complication rates were achieved with each configuration examined. There was no difference in fusion rates between the group without (Group 1) and those with (Groups 2 and 3) C-1 instrumentation. These findings indicated that in the pediatric population, excellent occipitocervical fusion rates can be accomplished without directly instrumenting C-1.

Original languageEnglish (US)
Pages (from-to)380-384
Number of pages5
JournalJournal of Neurosurgery: Pediatrics
Issue number4
StatePublished - Apr 2010
Externally publishedYes


  • Occipitocervical instability
  • Occipitocervical instrumentation
  • Pediatric occipitocervical fusion
  • Pediatric spinal instrumentation

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health
  • Clinical Neurology


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