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Nonmetallic posterior monosegmental cervical fusion of a dislocated C6/7 fracture in a 4-year-old girl

A case report

Metallfreie, monosegmentale, dorsale zervikale Fusion nach dislozierter HWS-Luxationsfraktur in Höhe C6/7 bei einem 4‑jährigen Mädchen

Ein Fallbericht

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Abstract

Purpose

Pediatric cervical spine injuries constitute approximately 1–2% of all pediatric trauma cases. Usually pediatric vertebral injuries appear as stable A type fractures, whereas B and C type injuries are relatively uncommon. In contrast to adults, the appropriate treatment strategy in children is still controversial and places spine surgeons in complex situations. This article reports the case of a 4-year-old girl with an unstable B type injury at the C6/7 level (AOSpine C6-7: B2 [F4 BL, C7:A1]) with bilateral locked fractures of the facet joints after falling down a flight of stairs.

Patient and methods

Magnetic resonance imaging (MRI) and computed tomography (CT) were initially performed. The 4‑year-old girl was treated under intraoperative neurophysiological monitoring via open reduction after partial resection of both C7 upper articular processes and nonmetallic monosegmental posterior interlaminar fusion (FiberWire®) at the C6/7 level with temporary immobilization in a halo brace.

Results

Clinical and radiological follow-up was carried out after 9 months. The patient suffered no pain or neurological deficits. Plain radiographs revealed a correct cervical alignment with anatomical correction of the initial dislocation.

Conclusion

The treatment of highly unstable pediatric B type injuries of the lower cervical spine via open reduction and nonmetallic monosegmental posterior interlaminar fusion results in good clinical and radiological outcomes. A temporary immobilization in a halo brace provides stability until osseous fusion occurs.

Zusammenfassung

Fragestellung

Kindliche zervikale Wirbelkörperfrakturen machen ca. 1–2 % aller Frakturen bei Kindern aus. Überwiegend handelt es sich bei den kindlichen Wirbelsäulenverletzungen um stabile A‑Frakturen, B‑ und C‑Verletzungen sind eher selten. Im Gegensatz zum Erwachsenen gibt die optimale Behandlung der kindlichen Verletzungen immer noch Anlass zur Diskussion und stellt den Wirbelsäulenchirurgen vor komplexe Herausforderungen. Dieser Beitrag berichtet über den Fall eines 4‑jährigen Mädchens mit instabiler B‑Verletzung in Höhe C6/7 (AOSpine C6-7: B2 [F4 BL, C7:A1]) mit beidseits verhakten Frakturen der Facettengelenke nach einem Treppensturz.

Methodik

Als initiale Diagnostik erfolgte eine Magnetresonanztomographie (MRT) und Computertomographie (CT) der Halswirbelsäule. Das 4‑jährige Mädchen wurde mit intraoperativem Neuromonitoring operiert. Es erfolgten die offene Reposition nach partieller beidseitiger Resektion des Processus articularis superior von C7 und eine metallfreie monosegmentale interlaminäre Fusion in Höhe C6/7 mittels FiberWire®. Additiv erfolgte die temporäre Anlage eines Halo-Fixateurs.

Ergebnisse

Eine klinische und radiologische Verlaufskontrolle erfolgte 9 Monate postoperativ. Das Mädchen beklagte keine Schmerzen oder neurologische Defizite. Die Röntgendiagnostik zeigte das korrekte Alignment der Halswirbelsäule mit anatomischer Reposition der initialen Fehlstellung.

Schlussfolgerung

Die offene Reposition und kurzstreckige, monosegmentale metallfreie Fusion kann eine adäquate Therapieoption bei kindlicher Luxationsfraktur der HWS darstellen. Additiv muss ein Halo-Fixateur angelegt werden, um eine Retention der HWS bis zur knöchernen Fusion zu sichern.

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Abbreviations

AOSpine:

AO Foundation spine classification system

CS:

Cervical spine

CT:

Computed tomography

MRI:

Magnetic resonance imaging

PCSI:

Pediatric cervical spine injury

SCIWORA:

Spinal cord injury without radiographic abnormality

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Authors and Affiliations

  1. Spine Center, Department of Orthopaedic Surgery, Trauma Surgery and Division of Spinal Cord Injury, Ruprecht Karls University Heidelberg, Schlierbacher Landstraße 200a, 69118, Heidelberg, Germany

    D. Adler, H. Almansour &  M. Akbar

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  1. D. Adler
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  2. H. Almansour
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  3. M. Akbar
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Correspondence to M. Akbar.

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D. Adler, H. Almansour and M. Akbar declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors. All procedures reported in this article were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For images or other information within the manuscript which identify the patient, consent was obtained from the patient and/or the legal guardian.

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Adler, D., Almansour, H. & Akbar, M. Nonmetallic posterior monosegmental cervical fusion of a dislocated C6/7 fracture in a 4-year-old girl. Orthopäde 48, 433–439 (2019). https://doi.org/10.1007/s00132-019-03714-9

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