Modern Instrumentation of the Pediatric Occiput and Upper Cervical Spine

HSS Journal Volume 11, Number 1 February, 2015

Daniel Hedequist, MD

Department of Orthopedic Surgery, Children’s Hospital Boston/Harvard Medical School, Boston, MA



Rigid screw rod techniques for cervical stabilization are widely used in adults. The benefits of rigid internal fixation include increased fusion rates, improvements in deformity correction, and diminished immobilization requirements. Applications of these techniques in children are challenging due to size constraints and the pathologic conditions encountered which require instrumented cervical fusions. Preparation as well as thorough understanding of the anatomy and surgical techniques is paramount to surgical safety in pediatric patients.


This review article serves as an educational tool regarding the use of modern posterior instrumentation techniques for pediatric cervical deformity.


Expert review based on clinical expertise and literature review.


The use of rigid screw rod instrumentation for the pediatric occiput and upper cervical spine is discussed. Preoperative imaging requirements for pediatric patients undergoing cervical spine surgery are reviewed. Anatomy, morphologic studies, and surgical techniques are discussed for each area of instrumentation.


Modern posterior cervical instrumentation techniques can be safely applied to the majority of pediatric patients who require an instrumented posterior cervical fusion. Patient safety revolves around thorough preoperative imaging tests, understanding of upper cervical anatomy, and meticulous surgical technique. Modern instrumentation leads to an improvement in fusion rates and a diminishment in immobilization requirements.

This article appears in the HSS Journal: Volume 11, Issue 1.
View the full HSS Journal at

About the HSS Journal

HSS Journal, an academic peer-reviewed journal published three times a year, February, July and October. The Journal accepts and publishes peer reviewed articles from around the world that contribute to the advancement of the knowledge of musculoskeletal diseases and disorders.


Back in the Game Patient Stories: