Traumatic atlanto-occipital dislocation in children: is external immobilization an option?

Abel, Taylor J.; Yan, Han; Canty, Michael; Remick, Madison; Dewan, Michael C.; Witiw, Christopher D.; Lamberti-Pasculi, Maria; Drake, James M.

doi:10.1007/s00381-020-04680-w

Cited by 8 publications

(9 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Vachata et al [ 48 ] reported that “two patients were in severe neurological states, with lesions of the upper cervical spinal cord and medulla oblongata on MRI, these patients were treated with external HF and died within 3 days of the trauma” [ 48 ]. In contrast, Able et al recently reported that treatment with HF was a safe, viable, and definitive treatment option for selected children with AOD [ 1 ]. Although several factors biased their results, Able et al reported good outcomes in eight out of ten patients with AOD (aged between newborn and 17) whose only therapy was external fixation with HF.…”

Section: Resultsmentioning

confidence: 99%

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Banat

Vychopen

Wach

et al. 2021

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose Traumatic cranio-cervical instability in childhood is rare and constitutes a challenge for the treating surgeon. The aim of therapy is to restore cervical stability without limiting the range of motion. The goal of this systematic review was to find out whether, over the last 10 years, halo fixation (HF) could still be considered a successful treatment option without major risks or complications. Methods We analyzed studies describing the use of HF in traumatic injuries of the cranio-cervical junction in children under the age of 17. Searches were performed in PubMed, MEDLINE and Embase databases for the years from 2010 to 2020. The general success rate, the success rate related to underlying pathologies, and complication rates were evaluated. Results The main indications for HF range from pre-surgical correction to postoperative fusion support. C2 is the most frequently injured vertebra in children. The overall success rate of HF was very high. Evaluation according to the underlying pathology showed that, except for atlanto-occipital dislocation, HF generates high fusion rates among different patient cohorts, mainly in C2 vertebra injuries and atlantoaxial rotatory subluxation. Only minor complications were reported, such as pin infections. Conclusion The current data show that, when used according to the appropriate indication, HF is an effective conservative treatment option for cranio-cervical instability, associated with only minor complications.

show abstract

Section: Resultsmentioning

confidence: 99%

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Banat

Vychopen

Wach

et al. 2021

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

show abstract

“…The question of how to select patients for whom conservative strategy is appropriate is both difficult and as-of-yet unanswered. [ 1 ]…”

Section: Discussionmentioning

confidence: 99%

“…Abel et al . [ 1 ] recently published their experience with external immobilization with halo for pediatric patients with AOD (with CT showing CCI > 5.0 mm or BDI > 8.0 mm). They report the outcomes for eight patients and none of them needed delayed surgery.…”

Section: Discussionmentioning

confidence: 99%

“…This has been described for patients with a “mild AOD”[ 9 ] or “incomplete AOD.”[ 16 ] Recently, neurosurgeons at Toronto’s Hospital for Sick Children published their experience with managing eight children with traumatic AOD with conventional halo immobilization. [ 1 ] We had also successfully managed a pediatric patient with traumatic atlanto-occipital dislocation with a conventional halo in 2014. [ 14 ] We report the first case of successful management of traumatic AOD in a 10-year-old boy with external immobilization using a noninvasive pinless halo.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of traumatic atlanto-occipital dislocation in a 10-year-old with noninvasive halo immobilization: A case report

Shekhar

Mancuso-Marcello

Emelifeonwu

et al. 2022

Surgical Neurology International

View full text Add to dashboard Cite

Background: Traumatic atlanto-occipital dislocation is an unstable injury of the craniocervical junction. For pediatric patients, surgical arthrodesis of the occipitocervical junction is the recommended management. While having a high success rate for stabilization, the fusion comes with obvious morbidity of limitation in cervical spine flexion, extension, and rotation. An alternative is external immobilization with a conventional halo. Case Description: We describe the case of a 10-year-old boy who was treated successfully for traumatic AOD with a noninvasive pinless halo. Following initial brain trauma management, we immobilized the craniocervical junction with a pinless halo after reducing the atlanto-occipital dislocation. The pinless halo was kept on at all times for the next 3 months. The craniocervical junction alignment was monitored with weekly cervical spine X-rays and CT craniocervical junction on day 15th, day 30th, and day 70th. A follow-up MRI C-spine 3 months from presentation confirmed resolution of the soft-tissue injury and the pinless halo was removed. Dynamic cervical spine X-rays revealed satisfactory alignment in both flexion and extension views. The patient has been followed up for 2 years postinjury and no issues were identified. Conclusion: Noninvasive pinless halo is a potential treatment option for traumatic pediatric atlanto-occipital dislocation. This should be considered bearing in mind multiple factors including age and weight of the patient, severity of the atlanto-occipital dislocation (Grade I vs. Grade II and incomplete vs. complete), concomitant skull and scalp injury, and patient’s ability to tolerate the halo. It is vital to emphasize that this necessitates close clinicoradiological monitoring.

show abstract

“…[1][2][3][4][5] Therefore, surgical removal and internal fixation are often required to maintain stability. [6][7][8][9] The most common methods of fixation are a subarticular atlantoaxial locking plate, a transoral atlantoaxial reduction plate, a Harms titanium plate, and a fabricated cage. [10][11][12] Recently, a 12-year-old boy with congenital skull-base depression was reported to have undergone odontoidectomy and internal fixation with plates and screws between the slopes and vertebral body.…”

Section: Introductionmentioning

confidence: 99%

Anatomical Study on the Safety of Anterior Cervical Craniovertebral Fusion with Clival Screw Placement in Children Aged 1–6 Years

Zhang

et al. 2021

IJGM

View full text Add to dashboard Cite

Objective This study aimed to investigate the safety of clival screw placement in children aged 1–6 years. Methods The cranial computed tomography data of 92 children aged 1–6 years were divided into three groups, according to age, for three-dimensional reconstruction. Three clival screw placement points were defined: (1) median point A at the middle and upper third of the tripartite distance from the spheno-occipital synchondrosis to the base of the skull; (2, 3) critical points B and C on the horizontal line with point A, where the screw placement passage was parallel to the sagittal plane. Parameters such as the passage length and angle were measured for horizontal, vertical facial, and extreme screw placement. Results The length parameters of the clival screw placement increased with age, and the screw passage length was the shortest for the vertical facial type in each age group. There were significant differences in all three groups between the length of screw placement in the vertical bone surface, the length of screw placement in the horizontal direction, and the length of screw placement on the limit at points A, B, and C ( P < 0.05); the length of screw placement on the vertical bone surface was the shortest. There was no significant difference between the horizontal screw length at point A and the extreme screw length ( P > 0.05). The difference between the horizontal screw length and the extreme screw length in the groups aged 1–2 years and 5–6 years was statistically significant ( P < 0.05), and the horizontal screw length was longer. Conclusion The cranial slope of children aged 1–6 years has the morphological basis for the placement of 3.5 mm screws, and each placement point has a safe angle range for screw placement.

show abstract

Traumatic atlanto-occipital dislocation in children: is external immobilization an option?

Cited by 8 publications

References 23 publications

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review

Management of traumatic atlanto-occipital dislocation in a 10-year-old with noninvasive halo immobilization: A case report

Anatomical Study on the Safety of Anterior Cervical Craniovertebral Fusion with Clival Screw Placement in Children Aged 1–6 Years

Contact Info

Product

Resources

About