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Published on: January 5, 2015
Instable cervical spine injury in a toddler: technical note
Oliver M Mueller1, Thomas Gasser, Arnd Hellwig
1Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany. oliver.mueller@uk-essen.de
Insights
This study presents a surgical technique for treating unstable upper cervical spine injuries (CSI) in a 15-month-old infant. The modified sublaminar wiring technique successfully fused the C2/3 vertebrae, preserving growth centers.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spine Surgery
Background:
- Instable upper cervical spine injuries (CSI) are rare in young children.
- Limited literature exists on operative management for pediatric CSI.
Observation:
- A 15-month-old infant sustained an unstable C2/3 luxation fracture after a fall.
- Halo vest immobilization failed to achieve repositioning.
Findings:
- A modified posterior midline sublaminar wiring technique was employed.
- The procedure preserved vertebral arch ossification zones.
- Postoperative halo vest immobilization achieved bony fusion at C2/3 without cervical lordosis.
Implications:
- This technical report details a novel surgical approach for pediatric CSI.
- The technique addresses the unique challenges of the immature pediatric cervical spine.
- Careful attention to growth centers is crucial for successful outcomes in pediatric spinal surgery.
Purpose:
Instable upper cervical spine injuries (CSI) in very young children are rare and consecutively only few data on the treatment and operative approaches exist in the literature. Hence, we suggest an operative strategy in the case of a 15-month-old infant treated for an instable CSI at the level of C2/3 at our department. Detailed steps of the operation with special consideration to the challenging anatomy of the immature spine are presented.
Methods:
A toddler suffered a CSI without neurological deficits after a stair fall. Computer tomography (CT) and magnetic resonance imaging (MRI) of the cervical spine revealed an instable luxation fracture of C2/3. As repositioning in the halo vest immobilization failed, surgical fusion was indicated.
Results:
Via a posterior midline approach, the lamina of C2 and C3 was conflated in a modified sublaminar wiring technique using non-resorbable sutures, sparing the ossification zones of the vertebral arches. Postoperative immobilization in a halo vest facilitated bony fusion of the laminae at C2/3 without lordotic displacement of the cervical spine.
Conclusions:
We consider the instable CSI of the immature cervical in the very young a challenging situation for every treating physician. The particular features of the growing spine require special attention to avoid damage to the growth centers of the vertebrae. To our knowledge, this is the first technical report giving detailed information of an operative approach to the severely injured immature cervical spine and postoperative management.
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