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. 2025 Jul 14;11(1):18.
doi: 10.1038/s41394-025-00715-z.

Posterior cervical-thoracic spinal fixation using mandibular instrumentation to treat acute cervical spine traumatic instability in the young pediatric population

Chani M Taggart  1 , Paola G Pieri  1   2 , Daniel G Gridley  2   3 , Kote Chundu  2   4 , Ramin Jamshidi  1   2   5 , Salvatore C Lettieri  2   6   7 , Iman Feiz-Erfan  8   9
Affiliations

Posterior cervical-thoracic spinal fixation using mandibular instrumentation to treat acute cervical spine traumatic instability in the young pediatric population

Chani M Taggart et al. Spinal Cord Ser Cases. .

Abstract

Study design: Retrospective review.

Objective: Surgical fixation of the pediatric subaxial cervical spine poses significant challenges due to a mismatch between rigid adult cervical spine hardware and the size and shape of bone in a young (below 8 years of age) cervical spine.

Setting: Arizona, USA.

Methods: We conducted a retrospective review of our experience with subaxial cervical spine screw fixation using adult type mandibular instrumentation in pediatric patients younger than 8 years, symptomatic from acute traumatic cervical spine injury during the period of 2007 through 2023.

Results: We identified 5 patients with the mean age of 4.4 years (range 2-6 years) who all had spinal cord injury with subluxation or dislocation at C6-7. All patients underwent posterior cervico-thoracic fixation with mandibular instrumentation from C2 to the upper thoracic spine. There was one complication of a right vertebral artery occlusion by screw placement, which did not cause harm. Suboptimal screw placement was detected in 18.4% of screws, but no revision was needed, since it was asymptomatic. All patients fused successfully without significant hardware failure. The mean time of follow up was 91 months ranging from 33-187 months.

Conclusions: Mandibular screw and plate fixation was effective to treat the acutely traumatic unstable subaxial cervical spine in the young pediatric population. The rate of suboptimal screw placement may be reduced by placing shorter screws into the lamina, pedicles, or facets if the plate hole does not align for a standard trajectory needed for lateral mass or pedicle screw placement.

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Conflict of interest statement

Ethical approval: This retrospective chart review was conducted in accordance with the ethical standards of our institution and approved by the Valleywise Health Medical Center Institutional Review Board with waiver of informed consent due to minimal risk associated with analysis of de-identified medical records. Competing interests: The authors declare no competing interests.

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