Cervical spine injuries in children, part II: Management and special considerations

Easter, Joshua S.; Barkin, Roger M.; Rosen, Carlo L.; Ban, Kevin M.

doi:10.1016/j.jemermed.2010.03.018

Cited by 19 publications

(22 citation statements)

References 30 publications

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“…Fortunately, upper cervical spine injuries in children are rare, but are over represented due to their head and neck anatomy. As illustrated in this case, careful positioning of the injured child on a spine board is imperative to avoid any worsening of a possible cervical spine injury [17,18]. A child's large head size necessitates elevation of the torso on the spine board in order to avoid undue neck flexion.…”

Section: Discussionmentioning

confidence: 99%

Neurophysiological monitoring of displaced odontoid fracture reduction in a 3-year-old male

Fox

Allen

Norton

2018

Spinal Cord Ser Cases

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Section: Discussionmentioning

confidence: 99%

Neurophysiological monitoring of displaced odontoid fracture reduction in a 3-year-old male

Fox

Allen

Norton

2018

Spinal Cord Ser Cases

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“…Patients can be treated with halos or hard collars, specially designed for AAI induced by cervical spine trauma. The American Academy of Neurological Surgeons recommends that the rigid collar be used to reduce the cervical injury for the first 4 weeks and, if unsuccessful, immobilization should be continued [18]. Both Dickman et al [19] and Lo et al [20] showed that a cervical orthosis collar or halo device can be successfully used for AAI induced by the transverse atlantal ligament.…”

Section: Discussionmentioning

confidence: 99%

“…When considering perioperative complications, many authors also recommend conservative management in patients with Down syndrome and for asymptomatic patients with AAI [21,22]. However, there are many complications with prolonged nonoperative management including pin-site infection, pin loosening, recurrent subluxation and a high nonunion rate [18,23]. Hence, many authors recommend that the rigid collar be used first, followed by head-halter traction for 3-4 weeks.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Application of a Revised Screw Technique via the C1 Posterior Arch and Lateral Mass in the Pediatric Population

Tan

et al. 2013

Pediatr Neurosurg

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Objective: Pediatric patients with insufficient height (≤4 mm) of the C1 posterior arch may restrict atlas screw placement via the posterior arch and lateral mass (PALM). For these patients, we modified this technique, called the ‘pedicle exposure technique' (PET). We aimed to analyze the clinical feasibility and safety of the PET in the pediatric population. Methods: Twenty pediatric patients with atlantoaxial instability (AAI) were enrolled in this study. The average C1 posterior arch was 3.1 (2.5-3.9) mm on CT scan. All patients underwent the C1 PET and C2 pedicle screw fixation. The imaging was performed to evaluate the accuracy of screw placement and bony fusion. Results: Forty screws were inserted via C1 PALM using the PET. Venous plexus bleeding occurred in 1 patient and the internal wall of the C1 lateral mass was perforated in 1 patient. There were no perioperative neurological deficits or vertebral artery injury. Follow-up was performed in all 20 cases over a period ranging from 6 to 80 months. Bony union was seen within 3-6 months. At the final follow-up visit, 14 patients had experienced an improvement, while 6 had complete resolution of their neck pain. Myelopathy symptoms were improved in 9 patients with spinal compression. Conclusion: The PET is an effective alternative for pediatric AAI when the height of the C1 posterior arch is <4 mm. Because of the higher screw entry point through the C1 posterior arch, there is effective biomechanical stability and less irritation of the venous plexus and C2 nerve root.

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“…Moreover, the risk of instability combined with the potential consequence of progressive damage to the adjacent spinal cord and subsequent neurological damage may contribute to late functional impairment and warrant specific therapy [4][5][6][7]. Although treatment algorithms have been established in the adult population, the need for surgical intervention in the pediatric population remains controversial.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Management of Injuries to the Spinal Cord and Column in Pediatric Multiple-Trauma Patients

et al. 2010

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Injuries to the spinal column and cord in children are a rare condition. Epidemiological data could help to establish an evidence-based assessment and therapy of these patients. We present a retrospective chart analysis of children with spinal injuries who were admitted to the emergency room. The patients were analyzed regarding age, mechanism, and distribution of their injuries to all spinal regions and treatment strategies. Thirty-five children met the inclusion criteria with severe spinal injuries (Abbreviated Injury Scale [AIS] for Region 6 [spine]; AIS region 6) in a period from January 2003 to December 2009. The incidence was extremely low in younger children, with increasing numbers during adolescence. Neurological deficit without fracture accounted for almost 25% of all patients. The majority of patients were treated conservatively; operative treatment was performed in 25% of patients with unstable fractures, particularly in adolescents. Treatment strategies differ according to the type and degree of injury, age, and level of spine maturation.

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Cervical spine injuries in children, part II: Management and special considerations

Cited by 19 publications

References 30 publications

Neurophysiological monitoring of displaced odontoid fracture reduction in a 3-year-old male

Neurophysiological monitoring of displaced odontoid fracture reduction in a 3-year-old male

Clinical Application of a Revised Screw Technique via the C1 Posterior Arch and Lateral Mass in the Pediatric Population

Epidemiology and Management of Injuries to the Spinal Cord and Column in Pediatric Multiple-Trauma Patients

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