Charles H Crawford1,2, Ian Mutchnick3, Leah Y Carreon4. 1. Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA. 2. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. 3. Norton Neuroscience Institute, 210 East Gray Street Suite 1105, Louisville, KY, 40202, USA. 4. Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. leah.carreon@nortonhealthcare.org.
Abstract
BACKGROUND: Caring for pediatric spine trauma patients places spine surgeons in situations that require unique solutions for complex problems. Recent case reports have highlighted a specific injury pattern to the lower cervical spine in very young children that is frequently associated with complete spinal cord injury. METHODS: This report describes the presentation and treatment of a C6-C7 dislocation in a 3-year-old patient with an incomplete spinal cord injury. The highly unstable cervical injury and the need to prevent neurologic decline added complexity to the case. RESULTS: A multi-surgeon team allowed for ample manpower to position the patient; with individuals with the requisite training and experience to safely move a patient with a highly unstable cervical spine. Initial closed reduction under close neurophysiologic monitoring, posterior fusion and immediate anterior stabilization lead to a successful patient outcome with preserved neurologic function. A traumatic cerebrospinal fluid leak, while a concern early on during the procedure, resolved without direct dural repair and did not complicate the patient's fusion healing. Additional anterior stabilization and fusion allowed long-term stability with bone healing that may not be achievable with posterior fixation and/or soft tissue healing alone. CONCLUSIONS: Familiarity with the challenges and solutions presented in the case may be useful to surgeons who could face a similar challenge in the future.
BACKGROUND: Caring for pediatric spine traumapatients places spine surgeons in situations that require unique solutions for complex problems. Recent case reports have highlighted a specific injury pattern to the lower cervical spine in very young children that is frequently associated with complete spinal cord injury. METHODS: This report describes the presentation and treatment of a C6-C7 dislocation in a 3-year-old patient with an incomplete spinal cord injury. The highly unstable cervical injury and the need to prevent neurologic decline added complexity to the case. RESULTS: A multi-surgeon team allowed for ample manpower to position the patient; with individuals with the requisite training and experience to safely move a patient with a highly unstable cervical spine. Initial closed reduction under close neurophysiologic monitoring, posterior fusion and immediate anterior stabilization lead to a successful patient outcome with preserved neurologic function. A traumatic cerebrospinal fluid leak, while a concern early on during the procedure, resolved without direct dural repair and did not complicate the patient's fusion healing. Additional anterior stabilization and fusion allowed long-term stability with bone healing that may not be achievable with posterior fixation and/or soft tissue healing alone. CONCLUSIONS: Familiarity with the challenges and solutions presented in the case may be useful to surgeons who could face a similar challenge in the future.
Authors: Robert F Murphy; Austin R Davidson; Derek M Kelly; William C Warner; Jeffrey R Sawyer Journal: J Pediatr Orthop Date: 2015-03 Impact factor: 2.324
Authors: Jeffrey B Knox; John E Schneider; Jason M Cage; Robert L Wimberly; Anthony I Riccio Journal: J Pediatr Orthop Date: 2014 Oct-Nov Impact factor: 2.324