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

Spinal Cord Series and Cases volume 11, Article number: 18 (2025) Cite this article

Subjects

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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Fig. 1: The mandibular plating system.
Fig. 2: Treatment progression.
Fig. 3: Example of screw backout.
Fig. 4: Trans-laminar screw.
Fig. 5: Screw trajectories.

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Data availability

The data generated and/or analyzed during the current study is available from the corresponding author on reasonable request.

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Funding

No financial assistance was received in support of this study.

Author information

Authors and Affiliations

  1. Division of Trauma, Creighton University School of Medicine-Phoenix, Valleywise Health Medical Center, Phoenix, AZ, USA

    Chani M. Taggart, Paola G. Pieri & Ramin Jamshidi

  2. University of Arizona College of Medicine, Phoenix, AZ, USA

    Paola G. Pieri, Daniel G. Gridley, Kote Chundu, Ramin Jamshidi, Salvatore C. Lettieri & Iman Feiz-Erfan

  3. Department of Radiology, Creighton University School of Medicine-Phoenix, Valleywise Health Medical Center, Phoenix, AZ, USA

    Daniel G. Gridley

  4. Department of Pediatrics, Creighton University School of Medicine-Phoenix, Valleywise Health Medical Center, Phoenix, AZ, USA

    Kote Chundu

  5. Division of Pediatric Surgery, Creighton University School of Medicine-Phoenix, Valleywise Health Medical Center, Phoenix, AZ, USA

    Ramin Jamshidi

  6. Division of Plastic Surgery, Creighton University School of Medicine-Phoenix, Valleywise Health Medical Center, Phoenix, AZ, USA

    Salvatore C. Lettieri

  7. Division of Plastic Surgery, Mayo Clinic, Phoenix, AZ, USA

    Salvatore C. Lettieri

  8. Division of Neurosurgery, Creighton University School of Medicine-Phoenix, Valleywise Health Medical Center, Phoenix, AZ, USA

    Iman Feiz-Erfan

Authors
  1. Chani M. Taggart
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Contributions

CT assisted with critical review. PP assisted with data collection and critical review. DG assisted with imaging data collection and critical review. KC assisted with critical review. RJ assisted with critical review. SL assisted with methodology design, data collection, and critical review. IFE assisted with conceptualization, methodology, data collection, data analysis, manuscript writing, and critical review.

Corresponding author

Correspondence to Iman Feiz-Erfan.

Ethics declarations

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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Taggart, C.M., Pieri, P.G., Gridley, D.G. et al. Posterior cervical-thoracic spinal fixation using mandibular instrumentation to treat acute cervical spine traumatic instability in the young pediatric population. Spinal Cord Ser Cases 11, 18 (2025). https://doi.org/10.1038/s41394-025-00715-z

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