Pseudosubluxation of C2 on C3 in Polytraumatized Children — Prevalence and Significance

Cervical spine trauma in children: a review

“…In pediatric patients with trauma, pseudosubluxation is not associated with intubation, injury severity, or outcome, from which we infer that pseudosubluxation is an incidental finding in these cases. 84 The only variable that correlates with pseudosubluxation appears to be age; this condition occurs in children up to 14 years of age. Shaw and colleagues 84 have provided strict criteria for determining the presence of pseudosubluxation.…”

“…84 The only variable that correlates with pseudosubluxation appears to be age; this condition occurs in children up to 14 years of age. Shaw and colleagues 84 have provided strict criteria for determining the presence of pseudosubluxation. A line drawn through the posterior arches of C-1 and C-3 should touch, pass through, or lie within 1 mm anterior to the anterior cortex of the posterior arch of C-2.…”

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

“…For example, imaging frequently reveals pseudosubluxation of C2 on C3 in pediatric patients (Figure 1). A retrospective review of 138 children without trauma identified this pseudosubluxation on 22% of plain films (11). This phenomenon is more common in younger children, with 46% of normal children Ͻ 8 years of age having 3 mm or more of anterior-posterior displacement of C2 on C3 on flexion-extension X-ray studies (12).…”

Physiologic anterior subluxation: Case report of occurrence at C5 to C6 and C6 to C7 spinal levels

“…5,8,12 The term ''pseudosubluxation'' is commonly assigned to the phenomenon reported here. [5][6][7][8][9][10][11] ''Physiologic anterior subluxation'' is a more accurate term to describe the normal forward displacement of vertebral bodies in the immature cervical spine because the subluxation is a real phenomenon. Moreover, the term distinguishes itself from physiologic posterior subluxation, which is also, but less frequently, observed in the pediatric cervical spine, typically at the C 2 to C 3 spinal level in extension.…”

“…It represents true, minor subluxation of the cervical spine, which occurs normally in children because of unique anatomic and biomechanical characteristics compared with that of adults. Physiologic anterior subluxation most commonly occurs in the upper cervical spine of infants and children 1-12 but occasionally persists into adolescence 3,6,8,10,11 and young adulthood. 8 Physiologic anterior subluxation can be seen in children admitted with multiple trauma, 11 when it must be distinguished from pathologic subluxation.…”