Management of Cervical Spine Anomalies in Children

Initial Management at Presentation

• Occipitocervical instability: Posterior occipitocervical fusion with O-C2 instrumentation and rib autograft is indicated.
• Atlantoaxial instability: Posterior C1-2 instrumentation and fusion with allograft and bone morphogenetic protein is most desirable, although autograft can be used. Instrumentation includes either C1-2 transarticular screw fixation or C1 lateral mass/C2 pars construct.
• Subaxial cervical instability: Either posterior or anterior cervical instrumentation and fusion are indicated.

Adjunctive Therapies

• Physiotherapy: Aside from the possible need for physical therapy, no adjunctive therapies are generally required.

Follow-up

• Occipitocervical instability: Plain films are obtained 1 and 2 months postoperatively. Cervical CT is obtained 4 months postoperatively to document fusion.
• Atlantoaxial instability: Plain films are obtained 1, 2, and 3 months postoperatively to document fusion.
• Subaxial cervical instability: Plain films are obtained 1, 2, and 3 months postoperatively to document fusion.