Rakesh Gupta1, Sharadendu Narayan2. 1. Department of Neurosurgery, Sri Aurobindo Medical College & P.G Institute, Indore, India. 2. Department of Neurosurgery, Sri Aurobindo Medical College & P.G Institute, Indore, India. sharad_jsr@yahoo.com.
Abstract
BACKGROUND: The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury. METHODS: In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done. CT spine suggested instability as there was anterior angulation of the odontoid process with anterior displacement and associated occipital fracture. Patient underwent a sublaminar wiring at C1-C2 vertebra. RESULTS: There was neurological improvement following surgery and patient was discharged after 2 weeks on soft cervical collar. Synchondrotic odontoid fracture is traditionally managed with closed reduction and external stabilization due to high rates of fusion in children. CONCLUSIONS: However, early surgical intervention has an important role in management of unstable injuries. Sublaminar wiring though not as stable as rigid instrumentation can be done in pediatric patients where even the smallest instrumentation is too invasive. Management of the odontoid synchondrosis fracture remains a controversial topic in children of younger age group.
BACKGROUND: The pediatric age group presents a challenge in diagnosis and management of upper cervical injuries. Cervical spine injuries are relatively rare in children as compared to adults and C2 vertebra is the commonly affected site for fracture and injury. METHODS: In our case, a 4-year-old female child was brought to the emergency after being hit over the head and neck by a falling wooden beam. Patient had associated minimal neurological deficits. Urgent CT scan of the head and cervical spine were done. CT spine suggested instability as there was anterior angulation of the odontoid process with anterior displacement and associated occipital fracture. Patient underwent a sublaminar wiring at C1-C2 vertebra. RESULTS: There was neurological improvement following surgery and patient was discharged after 2 weeks on soft cervical collar. Synchondrotic odontoid fracture is traditionally managed with closed reduction and external stabilization due to high rates of fusion in children. CONCLUSIONS: However, early surgical intervention has an important role in management of unstable injuries. Sublaminar wiring though not as stable as rigid instrumentation can be done in pediatric patients where even the smallest instrumentation is too invasive. Management of the odontoid synchondrosis fracture remains a controversial topic in children of younger age group.
Authors: C V A Kinkpé; A V Dansokho; N F Coulibaly; M M Niane; S I L Sèye; J Sales De Gauzy Journal: Orthop Traumatol Surg Res Date: 2009-04-17 Impact factor: 2.256
Authors: Scott Y Rahimi; E Andrew Stevens; David John Yeh; Ann Marie Flannery; Haroon Fiaz Choudhri; Mark R Lee Journal: Neurosurg Focus Date: 2003-12-15 Impact factor: 4.047