Sublaminar wiring for odontoid synchondrotic fracture stabilization in a 4-year-old: a case report
Rakesh Gupta1, Sharadendu Narayan2
1Department of Neurosurgery, Sri Aurobindo Medical College & P.G Institute, Indore, India.
Insights
Pediatric upper cervical spine injuries, particularly C2 fractures, pose diagnostic challenges. Early surgical intervention with sublaminar wiring can be effective for unstable injuries in young children.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Trauma Care
Background:
- Upper cervical spine injuries in children are rare but challenging to manage.
- The C2 vertebra is a common site for fractures and injuries in this age group.
Observation:
- A 4-year-old child sustained an unstable occipital fracture and anterior displacement of the odontoid process after head trauma.
- The patient presented with minimal neurological deficits.
Findings:
- Urgent CT scans confirmed cervical spine instability.
- Surgical intervention via C1-C2 sublaminar wiring resulted in neurological improvement.
Implications:
- Early surgical management is crucial for unstable pediatric cervical spine injuries.
- Sublaminar wiring offers a less invasive surgical option for young children compared to rigid instrumentation.
- The management of odontoid synchondrosis fractures in very young children remains a debated topic.
Background:
The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury.
Methods:
In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done. CT spine suggested instability as there was anterior angulation of the odontoid process with anterior displacement and associated occipital fracture. Patient underwent a sublaminar wiring at C1-C2 vertebra.
Results:
There was neurological improvement following surgery and patient was discharged after 2 weeks on soft cervical collar. Synchondrotic odontoid fracture is traditionally managed with closed reduction and external stabilization due to high rates of fusion in children.
Conclusions:
However, early surgical intervention has an important role in management of unstable injuries. Sublaminar wiring though not as stable as rigid instrumentation can be done in pediatric patients where even the smallest instrumentation is too invasive. Management of the odontoid synchondrosis fracture remains a controversial topic in children of younger age group.
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