OBJECTIVE: Traumatic lesions of upper cervical spine are rare in children. To evaluate their experience with this lesions and factors affecting outcome, authors conducted a retrospective study of 28 cases of upper pediatric cervical spine injuries treated in the last 25 years. MATERIALS AND METHODS: To help in treatment of these lesions, we studied our series and reviewed the literature. Patients were divided into three groups: 0 to 2, 3 to 8, and 9 to 16 years, and managed according to status at presentation and type of injury. RESULTS: Seven patients were managed surgically and 21 nonsurgically (3 halo braces, 18 hard collars or molded braces). Patients in the younger age group sustained more neurological injuries than the others. In group 1, 33% present a fracture/luxation of C0/C1 or odontoid. In group 2, 80% had sustained fracture/luxations of C2. In group 3, 60% present odontoid fractures. At late follow-up review, solid fusions were demonstrated in all patients. Neurological deterioration occur in six patients. The mortality rate was 12%. Compared with other authors' report, incidence of this lesions increased but not the number of those managed surgically. CONCLUSIONS: Management must be tailored to the patient's age, neurological status, type, and level of injury. Compared with other author's experience, fusion and instrumentation procedures were used less frequently. Signs of medullary compression, significant spine deformation, dynamic instability, and age higher than 8 years are the criteria for surgery. The criteria for instability in children are different from those used in adults because the residual spinal growth is a major concern. The best treatment is therefore preventive.
OBJECTIVE:Traumatic lesions of upper cervical spine are rare in children. To evaluate their experience with this lesions and factors affecting outcome, authors conducted a retrospective study of 28 cases of upper pediatric cervical spine injuries treated in the last 25 years. MATERIALS AND METHODS: To help in treatment of these lesions, we studied our series and reviewed the literature. Patients were divided into three groups: 0 to 2, 3 to 8, and 9 to 16 years, and managed according to status at presentation and type of injury. RESULTS: Seven patients were managed surgically and 21 nonsurgically (3 halo braces, 18 hard collars or molded braces). Patients in the younger age group sustained more neurological injuries than the others. In group 1, 33% present a fracture/luxation of C0/C1 or odontoid. In group 2, 80% had sustained fracture/luxations of C2. In group 3, 60% present odontoid fractures. At late follow-up review, solid fusions were demonstrated in all patients. Neurological deterioration occur in six patients. The mortality rate was 12%. Compared with other authors' report, incidence of this lesions increased but not the number of those managed surgically. CONCLUSIONS: Management must be tailored to the patient's age, neurological status, type, and level of injury. Compared with other author's experience, fusion and instrumentation procedures were used less frequently. Signs of medullary compression, significant spine deformation, dynamic instability, and age higher than 8 years are the criteria for surgery. The criteria for instability in children are different from those used in adults because the residual spinal growth is a major concern. The best treatment is therefore preventive.
Authors: Manuel Ribeiro da Silva; Daniela Linhares; Pedro Cacho Rodrigues; Eurico Lisboa Monteiro; Manuel Santos Carvalho; Pedro Negrão; Rui Peixoto Pinto; Nuno Neves Journal: Int Orthop Date: 2016-04-06 Impact factor: 3.075
Authors: John Kuluz; Amer Samdani; David Benglis; Manuel Gonzalez-Brito; Juan P Solano; Miguel A Ramirez; Ali Luqman; Roosevelt De los Santos; David Hutchinson; Mike Nares; Kyle Padgett; Dansha He; Tingting Huang; Allan Levi; Randal Betz; Dalton Dietrich Journal: J Spinal Cord Med Date: 2010 Impact factor: 1.985
Authors: Oliver M Mueller; Thomas Gasser; Arnd Hellwig; Christian Dohna-Schwake; Ulrich Sure Journal: Childs Nerv Syst Date: 2010-04-08 Impact factor: 1.475
Authors: Andrew T Hale; Abraham Alvarado; Amita K Bey; Sumit Pruthi; Gregory A Mencio; Christopher M Bonfield; Jeffrey E Martus; Robert P Naftel Journal: Childs Nerv Syst Date: 2017-06-27 Impact factor: 1.475