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Use of halo fixation therapy for traumatic cranio-cervical instability in children: a systematic review. Eur J Trauma Emerg Surg 2021; 48:3505-3511. [PMID: 34881392 PMCID: PMC9532283 DOI: 10.1007/s00068-021-01849-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 11/23/2021] [Indexed: 11/02/2022]
Abstract
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.
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Fromm J, Meuwly E, Wendling-Keim D, Lehner M, Kammer B. Clival fractures in children: a challenge in the trauma room setting! Childs Nerv Syst 2021; 37:1199-1208. [PMID: 33245407 DOI: 10.1007/s00381-020-04963-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE A clival fracture is a rare but life-threatening traumatic brain injury in the adult and pediatric populations. To date, there are very few conclusive recommendations in the literature concerning the diagnosis and treatment of pediatric clival fractures. METHODS In 2014 and 2015, two pediatric patients with severe blunt head trauma and clival fractures were evaluated and treated at a level I trauma center. Both cases are documented and supplemented by an extensive review of the literature focusing on the diagnostic workup, classification, and clinical course of clival fractures in children. RESULTS The clinical course of two children (8 and 9 years old) with clival fractures in concert with other intra- and extracranial injuries was analyzed. A total of 17 papers encompassing 37 patients (age range, 1-18 years) were included for a systematic review. The literature review revealed a mortality rate of 23% in pediatric patients with a clival fracture. Over 50% of the patients presented with cranial nerve damage, and two-thirds suffered from intracranial vascular damage or intracerebral bleeding. CONCLUSIONS Clival fractures are a very rare but severe consequence of blunt head trauma in the pediatric population and may be challenging to diagnose, especially in cases with an unfused sphenooccipital synchondrosis. Vascular damage following clival fractures appears to be as common in pediatric patients as in adults. Therefore, contrast-enhanced CT of the cervical spine and head and/or magnetic resonance angiography is strongly recommended to rule out vascular injury of the extra- and intracranial brain-supplying vessels within the trauma room setting.
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Affiliation(s)
- Julian Fromm
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Eliane Meuwly
- Department of Pediatric Surgery, Children's Hospital Lucerne, Luzerner Kantonsspital, Spitalstrasse 20, 6000, Lucerne 16, Switzerland
| | - Danielle Wendling-Keim
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Markus Lehner
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Lindwurmstr. 4, 80337, Munich, Germany. .,Department of Pediatric Surgery, Children's Hospital Lucerne, Luzerner Kantonsspital, Spitalstrasse 20, 6000, Lucerne 16, Switzerland.
| | - Birgit Kammer
- Pediatric Radiology, Department of Clinical Radiology, Ludwig-Maximilians-University Munich, Lindwurmstr. 4, 80337, Munich, Germany
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Meinig H, Matschke S, Ruf M, Pitzen T, Disch A, Jarvers JS, Herren C, Weiß T, Jung MK, Rüther H, Welk T, Badke A, Gonschorek O, Heyde CE, Kandziora F, Knop C, Kobbe P, Scholz M, Siekmann H, Spiegl U, Strohm P, Strüwind C, Kreinest M. [Diagnostics and treatment of cervical spine trauma in pediatric patients : Recommendations from the Pediatric Spinal Trauma Group]. Unfallchirurg 2020; 123:252-268. [PMID: 32215667 DOI: 10.1007/s00113-020-00789-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Severe cervical spine injuries in children under the age of 17 years are rare. Recommendations or even guidelines for the diagnostics and treatment of such injuries in children are currently not available. OBJECTIVE The aim of the study was to formulate recommendations for diagnostics and treatment of injuries of the cervical spine in pediatric patients. MATERIAL AND METHODS First, a search of primary and secondary literature on the topic complex of diagnostics and treatment of cervical spine injuries in children was carried out. An appropriate internal literature database was defined and maintained. Second, within the framework of 9 meetings from April 2017 to December 2019 the members of the Pediatric Spinal Trauma Group of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) systematically formulated recommendations for the diagnostics and treatment of injuries of the cervical spine in pediatric patients by a consensus process. RESULTS Recommendation for the diagnostics and treatment for injuries of the cervical spine could be formulated for three age groups (age group I: 0-6 years; age group II: 7-9 years; age group III: 10-16 years). The diagnostic and therapeutic principles known from adult patients suffering from injuries to the cervical spine cannot be easily transferred to pediatric patients. CONCLUSION Injuries to the pediatric spine are rare and should be treated in specialized spine centers. Pediatric patients with a stable cardiopulmonary status should undergo magnetic resonance imaging (MRI) if a spinal trauma is suspected. Classification systems and therapeutic recommendations for injuries to the cervical spine known from adult patients could also be used for adolescent patients. This is not possible for children under the age of 10 years. Only few classification systems exist for this age group. Basic principles of the treatment of spinal trauma in children is the restoration of spinal stability and correct anatomical relationships as well as the protection of all neural structures.
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Affiliation(s)
- Holger Meinig
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Deutschland
| | - Stefan Matschke
- Praxis für Wirbelsäulenchirurgie, ATOS Klinik Heidelberg, Heidelberg, Deutschland
| | - Michael Ruf
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Deutschland
| | - Tobias Pitzen
- Zentrum für Wirbelsäulenchirurgie, Orthopädie und Unfallchirurgie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Deutschland
| | - Alexander Disch
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Universitätsklinikum Dresden, Dresden, Deutschland
| | - Jan-Sven Jarvers
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Christian Herren
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Thomas Weiß
- Abteilung Wirbelsäulenchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Matthias K Jung
- Zentrum für Wirbelsäulenchirurgie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - Hauke Rüther
- Klinik für Unfallchirurgie, Orthopädie und Plastische Chirurgie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Thomas Welk
- Abteilung für Radiologie und Neuroradiologie, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Deutschland
| | - Andreas Badke
- Abteilung für Wirbelsäulenchirurgie, BG Klinik Tübingen, Tübingen, Deutschland
| | - Oliver Gonschorek
- Abteilung Wirbelsäulenchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Christoph E Heyde
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Frank Kandziora
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, BG Unfallklinik Frankfurt, Frankfurt, Deutschland
| | - Christian Knop
- Klinik für Unfallchirurgie und Orthopädie, Klinikum Stuttgart, Stuttgart, Deutschland
| | - Philipp Kobbe
- Klinik für Unfall- und Wiederherstellungschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - Matti Scholz
- Zentrum für Wirbelsäulenchirurgie und Neurotraumatologie, BG Unfallklinik Frankfurt, Frankfurt, Deutschland
| | - Holger Siekmann
- Department für Orthopädie, Unfall- und Wiederherstellungschirurgie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Ulrich Spiegl
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Peter Strohm
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Bamberg, Bamberg, Deutschland
| | - Christoph Strüwind
- Abteilung Wirbelsäulenchirurgie, BG Unfallklinik Murnau, Murnau, Deutschland
| | - Michael Kreinest
- Zentrum für Wirbelsäulenchirurgie, BG Klinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
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Liao S, Schneider NRE, Hüttlin P, Grützner PA, Weilbacher F, Matschke S, Popp E, Kreinest M. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction-A study in two new cadaveric trauma models. PLoS One 2018; 13:e0195215. [PMID: 29624623 PMCID: PMC5889057 DOI: 10.1371/journal.pone.0195215] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 03/13/2018] [Indexed: 12/11/2022] Open
Abstract
Background Unstable conditions of the craniocervical junction such as atlanto-occipital dislocation (AOD) or atlanto-axial instability (AAI) are severe injuries with a high risk of tetraplegia or death. Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in trauma patients. If the application of a cervical collar to a patient with an unstable craniocervical condition may cause segmental motion and secondary injury to the spinal cord is unknown. The aim of the current study is (i) to analyze compression on the dural sac and (ii) to determine relative motion of the cervical spine during the procedure of applying a cervical collar in case of ligamentous unstable craniocervical junction. Methods and findings Ligamentous AOD as well as AOD combined with ligamentous AAI was simulated in two newly developed cadaveric trauma models. Compression of the dural sac and segmental angulation in the upper cervical spine were measured on video fluoroscopy after myelography during the application of a cervical collar. Furthermore, overall three-dimensional motion of the cervical spine was measured by a motion tracking system. In six cadavers each, the two new trauma models on AOD and AOD combined with AAI could be implemented. Mean dural sac compression was significantly increased to -1.1 mm (-1.3 to -0.7 mm) in case of AOD and -1.2 mm (-1.6 to -0.6 mm) in the combined model of AOD and AAI. Furthermore, there is a significant increased angulation at the C0/C1 level in the AOD model. Immense three-dimensional movement up to 22.9° of cervical spine flexion was documented during the procedure. Conclusion The current study pointed out that applying a cervical collar in general will cause immense three-dimensional movement. In case of unstable craniocervical junction, this leads to a dural sac compression and thus to possible damage to the spinal cord.
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Affiliation(s)
- Shiyao Liao
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Niko R. E. Schneider
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Petra Hüttlin
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Paul A. Grützner
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Frank Weilbacher
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Stefan Matschke
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
| | - Erik Popp
- University Hospital Heidelberg, Department of Anesthesiology, Heidelberg, Germany
| | - Michael Kreinest
- BG Trauma Center Ludwigshafen, Department of Trauma Surgery and Orthopaedics, Ludwigshafen, Germany
- * E-mail:
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