Compression Myelopathy due to Proliferative Changes around C2 Pars Defects without Instability

A New Minimally Invasive Technique for Primary Unstable C2 Spondylolysis in an 8-Year-Old Child: A Case Report and Review of the Literature

BACKGROUND

Posterior arch defect of C2 with an unstable spondylolysis is a rare condition mostly occurring within children. Its management is still controversial.

CASE DESCRIPTION

We report in this article the first minimally invasive surgery (MIS) technique for this condition in an 8-year-old boy. A primary unstable C2 spondylolysis was diagnosed on the exploration of episodic paresthesia of upper limbs associated with headache lasting for several months. The surgical technique consisted in a direct pars repair through an MIS approach: METRx tubular retractor system (Medtronic Sofamor Danek, Memphis, Tennessee, USA), intraoperative C-arm fluoroscopy, surgical microscope, endoscopic spine instrument, and high-speed drill were required. Muscles were split and retracted. One-year postoperative course was excellent.

CONCLUSIONS

After reviewing the past literature of this pathology, we discuss the minimally invasive posterior approach of the upper cervical spine. It is the first case, to our knowledge, describing direct minimally invasive repair for bilateral primary C2 pars defect in a child. Image guidance and surgical microscope help safe and effective screw placement.