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Treatment of cervical subaxial injury in the very young child
Zühtü Özbek1, Emre Özkara2, Murat Vural2
1Department of Neurosurgery, School of Medicine, Eskisehir Osmangazi University, 26480, Eskisehir, Turkey. zuhtuozbek@gmail.com.
Insights
This study details a rare severe subaxial cervical spine injury in a 7-month-old infant, successfully treated with combined anterior and posterior surgical approaches. The infant showed significant neurological improvement, highlighting effective management of pediatric cervical spine trauma.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Trauma
Background:
- Infant cervical spines differ significantly from adults, with unique anatomical and biomechanical properties.
- Cervical spine trauma in infants is uncommon, particularly in the subaxial region, and presents differently than in older children or adults.
- Subaxial injuries and fracture-dislocations are rare in infants, making them challenging to diagnose and manage.
Introduction:
Infant's cervical spine has serious differences compared to other pediatric age groups and adults. Anatomical and biomechanical constitution of an infant is unique, and the pediatric spine gradually begins to resemble the structure of the adult spine after age 10. In addition, clinical presentation of the cervical spinal traumas has many distinctions from birth to the end of adolescence. In young children, cervical spine traumas are mainly localized in the upper cervical region. Trauma localized in subaxial cervical region and fracture-dislocations are rare in infants.
Case Report:
Here, we present a case history of a 7-month-old infant with surgically treated severe subaxial flexion-distraction injury. Neurologic examination revealed complete loss of motor function below C5. A whole-body CT was taken and we observed that C5-6 dislocated anteriorly approximately one vertebra size and also unilateral facet joint was locked. The patient was intubated and closed reduction was attempted with fluoroscopy under general anesthesia, but it was unsuccessful. Whereupon C5-6 microdiscectomy was performed with the anterior approach and fixation was provided with the craniofacial miniplate. Despite anterior stabilization, exact posterior alignment could not been achieved so, posterior approach was added to the surgery. At 12 month follow-up, the patient improved from quadriparesis to paraparesis and we achieved a satisfactory radiological outcome.
