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Management of a 3-year-old with an unstable C6-C7 diastasis without quadriplegia
Charles H Crawford1,2, Ian Mutchnick3, Leah Y Carreon4
1Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA.
Insights
Pediatric spine surgeons successfully treated a 3-year-old with a C6-C7 dislocation and spinal cord injury. Multi-surgeon intervention and combined anterior-posterior stabilization preserved neurologic function.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Pediatric spine trauma presents unique challenges for surgeons.
- Lower cervical spine injuries in young children are often associated with severe spinal cord injury.
Observation:
- A 3-year-old patient sustained a C6-C7 dislocation with an incomplete spinal cord injury.
- The injury was highly unstable, requiring immediate intervention to prevent further neurologic damage.
Findings:
- A multi-surgeon team performed closed reduction under neurophysiologic monitoring.
- Posterior fusion combined with immediate anterior stabilization resulted in preserved neurologic function.
- A cerebrospinal fluid leak resolved spontaneously, and bone healing was successful with combined fixation.
Implications:
- This case demonstrates a successful treatment strategy for complex pediatric cervical spine injuries.
- Combined anterior and posterior stabilization may offer superior long-term stability in these cases.
- Familiarity with such cases can aid surgeons in managing similar pediatric spinal trauma.
Background:
Caring for pediatric spine trauma patients places spine surgeons in situations that require unique solutions for complex problems. Recent case reports have highlighted a specific injury pattern to the lower cervical spine in very young children that is frequently associated with complete spinal cord injury.
Methods:
This report describes the presentation and treatment of a C6-C7 dislocation in a 3-year-old patient with an incomplete spinal cord injury. The highly unstable cervical injury and the need to prevent neurologic decline added complexity to the case.
Results:
A multi-surgeon team allowed for ample manpower to position the patient; with individuals with the requisite training and experience to safely move a patient with a highly unstable cervical spine. Initial closed reduction under close neurophysiologic monitoring, posterior fusion and immediate anterior stabilization lead to a successful patient outcome with preserved neurologic function. A traumatic cerebrospinal fluid leak, while a concern early on during the procedure, resolved without direct dural repair and did not complicate the patient's fusion healing. Additional anterior stabilization and fusion allowed long-term stability with bone healing that may not be achievable with posterior fixation and/or soft tissue healing alone.
Conclusions:
Familiarity with the challenges and solutions presented in the case may be useful to surgeons who could face a similar challenge in the future.
