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Trauma in congenital atlanto-axial dislocation
S N Bhagwati1, C E Deopujari, G D Parulekar
1Department of Neurosurgery, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
Summary
Trauma can acutely worsen congenital atlanto-axial dislocation (AAD) in children, causing paralysis. Surgical interventions like traction, fixation, and decompression offer treatment options, with outcomes depending on initial neurological status.
Area of Science:
- Pediatric Neurosurgery
- Spinal Deformities
- Congenital Abnormalities
Background:
- Congenital atlanto-axial dislocation (AAD) typically causes progressive cervico-medullary compression.
- Minor trauma can precipitate acute AAD, leading to quadriplegia and respiratory compromise.
Purpose of the Study:
- To analyze the impact of trauma on congenital AAD in children.
- To evaluate treatment strategies and outcomes for traumatic AAD in pediatric patients.
Main Methods:
- Retrospective review of 60 children with congenital AAD, focusing on 15 cases associated with trauma.
- Analysis of surgical interventions including skull traction, sublaminar wiring, occiput-to-C2 wiring, Hartshill loop, and posterior decompression.
- Assessment of outcomes based on the degree of neurological deficit.
Main Results:
- Trauma triggered acute AAD manifestations in 8 children (6 mobile, 2 fixed AAD).
- Three children experienced respiratory distress requiring ventilatory support; one died.
- Surgical outcomes varied, with successful reduction and fusion in some mobile AAD cases and decompression in fixed AAD.
- Overall results were contingent upon the initial neurological deficit severity.
Conclusions:
- Trauma is a significant factor in the acute presentation of congenital AAD in children.
- Diverse surgical techniques are employed, with outcomes closely linked to pre-treatment neurological status.
- Prompt management and appropriate surgical intervention are crucial for improving outcomes in pediatric AAD.