Skip to main content
SpringerLink
Log in

Treatment of cervical subaxial injury in the very young child

  • Grand Rounds
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Klimo P Jr, Ware ML, Gupta N, Brockmeyer D (2007) Cervical spine trauma in the pediatric patient. Neurosurg Clin N Am 18:599–620

    Article  PubMed  Google Scholar 

  2. McGrory BJ, Klassen RA, Chao EY, Staeheli JW, Weaver AL (1993) Acute fractures and dislocations of the cervical spine in children and adolescents. J Bone Jt Surg Am 75:988–995

    Article  CAS  Google Scholar 

  3. Mohseni S, Talving P, Branco BC, Chan LS, Lustenberger T, Inaba K (2011) Effect of age on cervical spine injury in pediatric population: a National Trauma Data Bank review. J Pediatr Surg 46:1771–1776

    Article  PubMed  Google Scholar 

  4. Holland MC, Kebriaei M, Wrubel D (2016) Posterior cervical spinal fusion in a 3-week-old infant with a severe subaxial distraction injury. J Neurosurg pediatr 17:353–356

    Article  PubMed  Google Scholar 

  5. Hott JS, Feiz-Erfan I, Kim LJ, Rekate HL, Sonntag VK (2004) Nonsurgical treatment of a C6–7 unilateral locked facet joint in an infant: case report. J Neurosurg 100:220–222

    PubMed  Google Scholar 

  6. Rooks VJ, Sisler C, Burton B (1998) Cervical spine injury in child abuse: report of two cases. Pediatr Radiol 28:193–195

    Article  PubMed  CAS  Google Scholar 

  7. Karandikar M, Mirza SK, Song K, Yang T, Krengel WF, Spratt KF (2012) Complex pediatric cervical spine surgery using smaller nonspinal screws and plates and intraoperative computed tomography. J Neurosurg Pediatr 9:594–601

    Article  PubMed  Google Scholar 

  8. Li V, Lopes DK, Bennett GJ (2001) Use of a craniofacial miniplate for internal fixation in a young child with cervical instability: case report. J Neurosurg Spine 95:128–131

    Article  CAS  Google Scholar 

  9. Ramrattan NN, Oner FC, Boszczyk BM, Castelein RM, Heini PF (2012) Cervical spine injury in the young child. Eur Spine J 21:2205–2211

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hwang SW, Gressot LV, Rangel-Castilla L, Whitehead WE, Curry DJ, Bollo RJ (2012) Outcomes of instrumented fusion in the pediatric cervical spine. J Neurosurg Spine 17:397–409

    Article  PubMed  Google Scholar 

  11. Fahim DK, Whitehead WE, Curry DJ, Dauser RC, Luerssen TG, Jea A (2010) Routine use of recombinant human bone morphogenetic protein-2 in posterior fusions of the pediatric spine: safety profile and efficacy in the early postoperative period. Neurosurgery 67:1195–1204

    Article  PubMed  Google Scholar 

  12. Osenbach RK, Menezes AH (1992) Pediatric spinal cord and vertebral column injury. Neurosurgery 30:385–390

    Article  PubMed  CAS  Google Scholar 

  13. Leonard JR, Jaffe DM, Kuppermann N, Olsen CS, Leonard JC (2014) Cervical spine injury patterns in children. Pediatrics 133(5):1179–1188

    Article  Google Scholar 

  14. Lustrin ES, Karakas SP, Ortiz AO, Cinnamon J, Castillo M, Vaheesan K (2003) Pediatric cervical spine: normal anatomy, variants, and trauma. Radiographics 23:539–560

    Article  PubMed  Google Scholar 

  15. American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2002) Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 50(3 suppl):85–99

    Google Scholar 

  16. Booth TN (2012) Cervical spine evaluation in pediatric trauma. Am J Roentgenol 198:417–425

    Article  Google Scholar 

  17. Anderson RC, Kan P, Vanaman M, Rubsam J, Hansen KW, Scaife ER, Brockmeyer DL (2010) Utility of a cervical spine clearance protocol after trauma in children between 0 and 3 years of age. J Neurosurg Pediatr 5(3):292–296

    Article  PubMed  Google Scholar 

  18. Brockmeyer DL, Ragel BT, Kestle JRW (2012) The pediatric cervical spine instability study: a pilot study assessing the prognostic value of four imaging modalities in clearing the cervical spine for children with severe traumatic injuries. Childs Nerv Syst 28:699–705

    Article  PubMed  Google Scholar 

  19. Baker C, Kadish H, Schunk JE (1999) Evaluation of pediatric cervical spine injuries. Am J Emerg Med 17:230–234

    Article  PubMed  CAS  Google Scholar 

  20. Jimenez RR, DeGuzman MA, Shiran S, Karrellas A, Lorenzo RL (2008) CT versus plain radiographs for evaluation of c-spine injury in young children: do benefits outweigh the risks? Pediatr Radiol 38:635–644

    Article  PubMed  Google Scholar 

  21. Khanna P, Chau C, Dublin A, Kim K, Wisner D (2011) The value of cervical magnetic resonance imaging in the evaluation of the obtunded or comatose patient with cervical trauma, no other abnormal neurologic findings, and a normal cervical computed tomography. J Trauma 20:1–4

    Google Scholar 

  22. Madura CJ, Johnston JM (2017) Classification and Management of Pediatric Subaxial Cervical Spine Injuries. Neurosurg Clin N Am 28:91–102

    Article  PubMed  Google Scholar 

  23. Radcliff K, Thomasson BG (2013) Flexion-distraction injuries of the subaxial cervical Spine. Semin Spine Surg 25:45–56

    Article  Google Scholar 

  24. Moore TA, Vaccaro AR, Anderson PA (2006) Classification of lower cervical spine injuries. Spine 31(11 suppl):38

    Google Scholar 

  25. Vaccaro AR, Hulbert RJ, Patel AA, Fisher C, Dvorak M, Lehman RA Jr, Anderson P, Harrop J, Oner FC, Arnold P, Fehlings M, Hedlund R, Madrazo I, Rechtine G, Aarabi B, Shainline M (2007) The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco–ligamentous complex. Spine 32(21):2367

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, School of Medicine, Eskisehir Osmangazi University, 26480, Eskisehir, Turkey

    Zühtü Özbek, Emre Özkara, Murat Vural & Ali Arslantaş

Authors
  1. Zühtü Özbek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emre Özkara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Murat Vural
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ali Arslantaş
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zühtü Özbek.

Ethics declarations

Funding

The manuscript submitted has no funds which were received in support of this work and no relevant financial activities outside the submitted work.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent for the publication of the case report was obtained from the parents of the baby girl.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Özbek, Z., Özkara, E., Vural, M. et al. Treatment of cervical subaxial injury in the very young child. Eur Spine J 27, 1193–1198 (2018). https://doi.org/10.1007/s00586-017-5316-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-5316-z

Keywords

Search

Navigation