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Published on: January 5, 2015
The anterior cervical approach for traumatic injuries to the cervical spine in children
1Department of Neurosurgery, Chaim Sheba Medical Center, Sackler School of Medicine, Tel-Hashomer, Israel.
Insights
The anterior surgical approach is effective for treating severe pediatric cervical spine injuries, offering direct visualization and leading to improved alignment and neurological function. This method promotes early mobility and long-term recovery in young patients.
Area of Science:
- Pediatric Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Traumatic cervical spine injuries in children often require nonoperative management.
- Posterior stabilization is a common surgical choice, but the anterior approach is indicated in specific pediatric cases.
- Severe injuries may involve vertebral body damage, posterior element disruption, disk involvement, and spinal cord compression.
Purpose of the Study:
- To evaluate the efficacy of the anterior operative approach for treating traumatic cervical spine injuries in children.
- To assess the outcomes of anterior decompression and bony fusion in pediatric patients with severe cervical spine trauma.
Main Methods:
- The anterior surgical approach was utilized in six pediatric patients (ages 3-14) with severe cervical spine trauma.
- Procedures included anterior decompression and bony fusion to correct deformities and relieve cord compression.
Main Results:
- All patients achieved normal anatomic alignment and demonstrated neurologic improvement post-operatively.
- Long-term follow-up (up to eight years) confirmed solid fusion and bone graft remodeling.
- The anterior approach facilitated direct lesion visualization, effective repair, and stabilization.
Conclusions:
- The anterior approach should be considered more frequently for pediatric traumatic cervical spine injuries.
- This technique allows for early ambulation, minimal morbidity, and significant long-term neurologic recovery.
Abstract:
In most cases of traumatic cervical spine injuries in children, nonoperative treatment, mainly external stabilization, is sufficient. When operative treatment is chosen, surgeons often recommend posterior stabilization. In a subset of pediatric patients, the anterior approach is indicated. The anterior operative approach was employed in six children three to 14 years of age who sustained trauma to the cervical spine. The injuries included severe hyperflexion injury with crush fracture and avulsion of the vertebral body, fracture-dislocation of the vertebral body with involvement of the posterior elements and the disk, and injuries that caused major anatomic deformity of the cervical spine with cord compression. Anterior decompression with bony fusion led to normal anatomic alignment with neurologic improvement in all patients. Follow-up evaluation as long as eight years showed solid fusion and remodeling of the bone grafts. The anterior approach should be used more frequently as the surgical procedure of choice in children with traumatic lesions of the cervical spine. The anterior approach provided direct visualization of the lesion, which enabled effective repair and stabilization, early ambulation with minimal morbidity, and significant long-term neurologic improvement.
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