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Challenges in Occipitocervical Fusion in a 9-Month-Old Infant: A Case Report and Review of Literature
Balamurugan Thirugnanam1, Ashish Kukreja1, Bopanna K Mandanna2
1Spine Care Centre, Manipal Hospital HAL Old Airport Road, Bengaluru, Karnataka, India.
Insights
Infantile cranio-cervical junction injuries require prompt surgical stabilization. This case demonstrates a successful occiput to C2 fusion in a 9-month-old infant with a complex fracture, achieving bony fusion.
Area of Science:
- Pediatric neurosurgery
- Orthopedic surgery
- Traumatology
Background:
- Infantile cranio-cervical junction injuries are rare but potentially fatal, necessitating early surgical intervention.
- The unique anatomy of infant occipitocervical junctions presents challenges for creating safe and biomechanically stable fusion constructs.
- A 9-month-old male infant presented with upper limb weakness due to a displaced odontoid synchondrosis fracture and occipitocervical/atlantoaxial dissociation.
Approach:
- Surgical stabilization via occiput to C2 arthrodesis was performed using dual distal radius locking plates.
- An autologous full-thickness parietal bone graft was utilized for fusion.
- Post-operative management included the application of a Minerva jacket.
Key Points:
- Computed tomography (CT) scan at 12 weeks confirmed successful bony fusion.
- This case highlights the successful surgical management of a complex traumatic cranio-cervical injury in an infant.
- Early and accurate diagnosis through comprehensive imaging assessment is crucial for managing these severe injuries.
Conclusions:
- Combined occipitocervical and atlantoaxial joint injuries in infants can be life-threatening.
- This surgical approach provides a safe and effective method for stabilizing severe cranio-cervical injuries in infants.
- Multimodal imaging is essential for the timely diagnosis and management of pediatric cranio-cervical trauma.
Abstract:
Traumatic cranio-cervical junction injuries in infants are rare and require early surgical stabilization. In view of the unique anatomy of the occipitocervical junction in infants, the creation of a fusion construct that is both safe and biomechanically sound is challenging. A 9-month-old male infant involved in an accident presented with weakness in both upper limbs. Imaging revealed a displaced odontoid synchondrosis fracture with combined occipitocervical and atlantoaxial dissociation. Due to the unstable nature of the injury, occiput to C2 arthrodesis using dual distal radius locking plates and autologous full-thickness parietal region calvarial bone graft was performed. Minerva jacket was applied. Computed tomography (CT) scan obtained at 12 weeks demonstrated evidence of bony fusion. Combined injuries to the occipitocervical and atlantoaxial joint in an infant can be fatal. A thorough assessment of multiple imaging modalities helps to make an early and accurate diagnosis.
