July 25, 2025
Mayo Clinic orthopedic surgeons perform surgical procedures only available at a handful of medical centers worldwide, treating pediatric and adolescent cervical deformity and instability.
Examples of these cervical spine conditions include:
- Severe congenital cervical spine deformity.
- Cervical deformity or instability associated with previous trauma or tumor surgery.
- Cervical spine conditions associated with skeletal dysplasia and other developmental conditions.
Cervical spine conditions in children and adolescents are uncommon and are also particularly challenging, says Anthony A. Stans, M.D., a pediatric orthopedic surgeon at Mayo Clinic in Minnesota.
More than a decade ago, Dr. Stans' experience on a Mayo Clinic surgical team to separate conjoined twins showed him the value of 3D anatomic models for performing complex pediatric congenital spine deformity surgery. He became one of the first surgeons to use 3D models for these types of medical conditions. To create the models, Dr. Stans works with a unique Mayo Clinic resource, an in-house 3D printing lab in Radiology. These models have been invaluable when evaluating atypical spine deformity, says Dr. Stans, allowing him to better understand the deformity, plan the operation, and improve patient safety and surgical results.
3D printed models also serve as an effective tool to educate patients and their families about a child's or adolescent's condition and the recommended surgery, says Dr. Stans. After surgery, he often gifts patients these models, which are built as a life-size replica of the patient's head and neck.
Pediatric cervical spine treatment protocol
Prior to surgery, patients are occasionally placed in halo gravity traction, which allows for gradual deformity correction.
"Manipulating the bones of the cervical spine carries significant risk, with the potential for life-threatening spinal cord injury," says Dr. Stans. "Halo gravity traction allows correction to occur slowly and safely over days — sometimes several weeks — with patients awake and able to report if they experience any problems."
Due to the high-risk nature of cervical spine treatment, Dr. Stans typically performs these operations with a neurosurgeon colleague, Jeremy L. Fogelson, M.D. An increasing body of literature shows that the best results when performing complex spine surgery for uncommon conditions occur when orthopedic surgeons and neurosurgeons operate together, says Dr. Stans. These two surgeons have been operating jointly on pediatric and adolescent patients with surgical spine conditions for over a decade.
During surgery, Dr. Stans and his team use state-of-the-art technology, including intraoperative CT scanning and computer navigation for screw and implant placement. These technological advances allow the implants to be placed in the safest and most effective manner during these high-risk operations.
"Surgical navigation technology not only promotes efficiency but also helps us operate on the patient in the safest way possible," he says, noting that it is especially useful for accuracy in operations in which the bony anatomy is abnormal, the result of either congenital deformity or previous surgery.
Operating rooms where Dr. Stans performs these surgeries are equipped with multiple monitors mounted on booms around the room so that he and his team can view the complex anatomy from multiple perspectives while performing the patient's operation.
Case example of a pediatric cervical spine deformity treatment
An example of the type of cervical deformity Dr. Stans treats was a young girl with severe congenital vertebral anomalies, whose head rested on her back. To correct this deformity, a multistage approach was needed. The initial operation involved performing multiple osteotomies to separate the congenitally fused vertebrae and application of a halo.
Over the next six weeks, increasing traction was applied through the halo. At the end of this period, the amount of traction was equal to her body weight, and the patient could lift her feet off the ground. The team monitored the patient's progress by X-ray, and her condition improved markedly over the month and one-half of presurgical traction, says Dr. Stans. Drs. Stans and Fogelson then performed posterior instrumentation and fusion to stabilize the young patient's head and neck in a near-normal anatomic position.
For more information
Refer a patient to Mayo Clinic.