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Dastagirzada YM, Konigsberg A, Thompson D, Anderson RCE. Pediatric cervical spine instability: evolving concepts. Childs Nerv Syst 2024:10.1007/s00381-024-06474-w. [PMID: 38900291 DOI: 10.1007/s00381-024-06474-w] [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: 09/16/2023] [Accepted: 05/25/2024] [Indexed: 06/21/2024]
Abstract
The pediatric cervical spine is structurally and biomechanically unique in comparison to adults. Guidelines to assess for cervical spine instability and standard of care treatments in the pediatric population have yet to be delineated. This is due to the rarity of the condition and the lack of multicenter data published on the topic. Our review explores the biomechanics of the pediatric cervical spine and highlights evolving concepts/research over the last several decades, with special attention to the Down syndrome and complex Chiari malformation cohorts.
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Affiliation(s)
| | | | - Dominic Thompson
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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2
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Lin J, Ji W, Huang Z, Huang Z, Zhu Q, Liu J. Feasibility of Anterior Fixation with Single Screw for Odontoid Fractures in Pediatrics: A Computed Tomographic Study. Orthop Surg 2023; 15:2566-2573. [PMID: 37537409 PMCID: PMC10549830 DOI: 10.1111/os.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/21/2023] [Accepted: 06/24/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE Although it is an effective fixation technique for an unstable odontoid, anterior fixation remains challenging in pediatric populations. Our study measures the anatomical parameters of the odontoid to identify the feasibility of anterior fixation with a single screw for children. METHODS We retrospectively collected data from 112 normal male and female children (aged between 2 and 18) in our institute from January 1, 2022 to December 31, 2022. Subjects were divided into a youth group (2-6 years old), a juvenile group (7-12 years old), and an adolescent group (13-18 years old). Sagittal and coronal computed tomography images of the upper cervical spine were used to measure the screw length, angle, and inner and outer diameters of the odontoid. One-way analysis of variance with the Tukey test was used to analyze the parameters among the groups, while the t-test was used to analyze gender differences. Correlations between parameters and age were assessed using Pearson's test. RESULTS There were significant differences between male and female subjects in screw length and inner and outer diameters (of both sagittal and coronal views) but not in screw angle. The narrowest diameter of the odontoid was 4.0 ± 1.5 mm in the youth group, 5.5 ± 1.5 mm in the juvenile group, and 5.6 ± 1.1 mm in the adolescent group, respectively. There were significant differences among the three groups in screw length (p < 0.0001). The screw angle of the adolescent group was significantly smaller than that of the youth and juvenile groups. More than 90% of children aged 7-18 years old had an odontoid diameter greater than 4 mm, while only half of the youth group had an odontoid with diameter >4 mm. Screw length and inner and outer diameters in lateral view were positively correlated with age, and screw angle was negatively correlated with age. CONCLUSION It is feasible to insert a standard single screw (Φ 3.5 mm) into the odontoid of children aged 7-18 years old but not those aged 2-6 years old. How the anatomical parameters of the odontoid change with age, especially the narrowest diameters, is worthy of attention.
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Affiliation(s)
- Junyu Lin
- Division of Spine Surgery, Department of OrthopaedicsNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Wei Ji
- Division of Spine Surgery, Department of OrthopaedicsNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Zucheng Huang
- Division of Spine Surgery, Department of OrthopaedicsNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Zhiping Huang
- Division of Spine Surgery, Department of OrthopaedicsNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Qingan Zhu
- Division of Spine Surgery, Department of OrthopaedicsNanfang Hospital, Southern Medical UniversityGuangzhouChina
| | - Junhao Liu
- Division of Spine Surgery, Department of OrthopaedicsNanfang Hospital, Southern Medical UniversityGuangzhouChina
- Division of Spine Surgery, Department of OrthopaedicsGuangzhou First People's Hospital, School of Medicine, South China University of TechnologyGuangzhouChina
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3
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Hect JL, McDowell MM, Fields D, Greene S. Relationship of cervical soft tissue injury and surgical predication following pediatric cervical spinal trauma and its sequelae on long-term neurologic outcome. World Neurosurg X 2023; 20:100235. [PMID: 37456687 PMCID: PMC10339037 DOI: 10.1016/j.wnsx.2023.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 06/02/2023] [Accepted: 06/12/2023] [Indexed: 07/18/2023] Open
Abstract
Within the sample of 181 patients with cervical CT, CT identified unstable injury with a sensitivity of 100% and specificity of 95%. CT identified operable injury at the CCJ with 86% sensitivity and 91% specificity. CT was considered the gold standard for identification of fractures. Together, the presence of CT imaging suggestive of unstable injury or persistent neurologic complaint had a 100% sensitivity and 81% specificity. Finally, across all patients MRI had 100% sensitivity and 89% specificity for detection of unstable injury requiring surgery.
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Affiliation(s)
- Jasmine L. Hect
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Michael M. McDowell
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Daryl Fields
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
| | - Stephanie Greene
- Department of Neurosurgery, Children's Hospital of Pittsburgh, Pittsburgh, USA
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, USA
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Cunha NSC, Malvea A, Sadat S, Ibrahim GM, Fehlings MG. Pediatric Spinal Cord Injury: A Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1456. [PMID: 37761417 PMCID: PMC10530251 DOI: 10.3390/children10091456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/14/2023] [Accepted: 08/23/2023] [Indexed: 09/29/2023]
Abstract
A spinal cord injury (SCI) can be a devastating condition in children, with profound implications for their overall health and quality of life. In this review, we aim to provide a concise overview of the key aspects associated with SCIs in the pediatric population. Firstly, we discuss the etiology and epidemiology of SCIs in children, highlighting the diverse range of causes. We explore the unique anatomical and physiological characteristics of the developing spinal cord that contribute to the specific challenges faced by pediatric patients. Next, we delve into the clinical presentation and diagnostic methods, emphasizing the importance of prompt and accurate diagnosis to facilitate appropriate interventions. Furthermore, we approach the multidisciplinary management of pediatric SCIs, encompassing acute medical care, surgical interventions, and ongoing supportive therapies. Finally, we explore emerging research as well as innovative therapies in the field, and we emphasize the need for continued advancements in understanding and treating SCIs in children to improve their functional independence and overall quality of life.
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Affiliation(s)
| | - Anahita Malvea
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON M5T 2S8, Canada;
| | - Sarah Sadat
- Institute of Medical Science, University of Toronto, Toronto, ON M5S 1A1, Canada;
| | - George M. Ibrahim
- Division of Neurosurgery, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada;
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
| | - Michael G. Fehlings
- Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, ON M5T 2S8, Canada;
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON M5S 1A1, Canada
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Wu EY, Curran PL, Zukowski M, King TS, Martin KL, Grant CN. Cervical Collar Clearance in Obtunded Children Presenting Without a Known Traumatic Mechanism: Is Imaging Necessary? J Pediatr Surg 2023; 58:1494-1499. [PMID: 37029027 DOI: 10.1016/j.jpedsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Obtunded pediatric patients are often placed in cervical collars (c-collars) to protect their cervical spine (c-spine) while injury is being ruled out, even without a known traumatic injury. The goal of this study was to determine the necessity of c-collars in this population by determining the rate of c-spine injury among patients with suspected non-traumatic mechanisms of loss of consciousness. METHODS A single institution, ten-year retrospective chart review was conducted including all obtunded patients admitted to the Pediatric Intensive Care Unit without a known traumatic event. Patients were categorized into five groups based on etiology of obtundation: respiratory, cardiac, medical/metabolic, neurologic, and other. Comparisons were made between those placed in a c-collar and a control group who were not, using Wilcoxon rank sum test for continuous measures, and Chi-square or Fisher's exact test for categorical measures. RESULTS 464 patients were included, of which 39 (8.41%) were placed in a c-collar. There was a significant difference in whether a patient was placed in a c-collar based on diagnosis category (p < 0.001). Those placed in a-c-collar were more likely to undergo imaging studies than the control group (p < 0.001). The overall incidence of c-spine injury in this patient population in our study was zero. CONCLUSION Cervical collar placement and radiographic evaluation is not necessary in obtunded pediatric patients who present without a known traumatic mechanism as the overall risk of injury is low. Consideration for collar placement should be given in cases when trauma cannot be definitively ruled out at initial evaluation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Emma Y Wu
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Pierce L Curran
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Monica Zukowski
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Tonya S King
- Department of Public Health Sciences, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Kathryn L Martin
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA; Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Christa N Grant
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA; Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA.
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Tucker S, Heneghan NR, Gardner A, Rushton A, Alamrani S, Soundy A. Factors Influencing Participation in Physical Activity, Sports, and Exercise in Children and Adolescents with Spinal Pain or Spinal Conditions: A Systematic Review and Meta-Ethnography. Behav Sci (Basel) 2023; 13:486. [PMID: 37366738 DOI: 10.3390/bs13060486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/01/2023] [Accepted: 06/04/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Physical activity is an effective treatment for paediatric spinal pain. However, participation rates remain low and review evidence is needed to establish why. This review identifies factors influencing participation in sports, exercise, and physical activity in those aged 18 or under with spinal pain or spinal conditions. Trends or differences between discrete sub-populations are identified. METHODS A meta-ethnographic review was undertaken. Qualitative papers were identified and appraised using the JBI checklist. Thematic trends were mapped onto the biopsychosocial model and subthemes identified. Uniqueness was calculated and the confidence in the evidence was evaluated using the GRADE-CERQual tool. RESULTS Data were gathered from nine qualitative papers (384 participants). Three themes were identified: (1) biological: physical challenges and bladder and bowel care; (2) psychological: perceptions of differences to peers, struggle, anger, sadness, adjustment, and acceptance; and (3) sociological: influence of friends, social acceptance, negative attitudes from others, and the influence of their disability on family routine. CONCLUSIONS Sociological factors were most influential on exercise participation alongside related psychological and biological factors. Adolescents over 14 years offered greater critical insight compared to the younger children. Results are best applied to neuromuscular conditions with further robust evidence required in paediatric musculoskeletal spinal pain.
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Affiliation(s)
- Susanna Tucker
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Nicola R Heneghan
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
| | - Adrian Gardner
- Spinal Surgery, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham B31 2AP, UK
| | - Alison Rushton
- School of Physical Therapy, Western University Canada, London, ON N6A 3K7, Canada
| | - Samia Alamrani
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
- Physical Therapy Department, University of Tabuk, Tabuk 47512, Saudi Arabia
| | - Andrew Soundy
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham B15 2TT, UK
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Vachata P, Lodin J, Bolcha M, Brušáková Š, Sameš M. Acute Progressive Pediatric Post-Traumatic Kyphotic Deformity. CHILDREN (BASEL, SWITZERLAND) 2023; 10:932. [PMID: 37371164 DOI: 10.3390/children10060932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 06/29/2023]
Abstract
Cervical kyphosis is a rare entity with challenging management due to the limitations of pediatric age, along with a growing spine. The pathogenesis is made up of a large group of congenital, syndromic and acquired deformities after posterior element deterioration or as a result of previous trauma or surgery. In rare progressive cases, kyphotic deformities may result in severe "chin-on-chest" deformities with severe limitations. The pathogenesis of progression to severe kyphotic deformity after minor hyperflexion trauma is not clear without an obvious MR pathology; it is most likely multifactorial. The authors present the case of a six-month progression of a pediatric cervical kyphotic deformity caused by a cervical spine hyperflexion injury, and an MR evaluation without the pathology of disc or major ligaments. Surgical therapy with a posterior fixation and fusion, together with the preservation of the anterior growing zones of the cervical spine, are potentially beneficial strategies to achieve an excellent curve correction and an optimal long-term clinical outcome in this age group.
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Affiliation(s)
- Petr Vachata
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
- Department of Neurosurgery, University Hospital in Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, 323 00 Pilsen, Czech Republic
| | - Jan Lodin
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
- Department of Neurosurgery, University Hospital in Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, 323 00 Pilsen, Czech Republic
| | - Martin Bolcha
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
- Department of Neurosurgery, University Hospital in Pilsen, The Faculty of Medicine in Pilsen, Charles University in Prague, 323 00 Pilsen, Czech Republic
| | - Štepánka Brušáková
- Department of Neurology, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
| | - Martin Sameš
- Department of Neurosurgery, J. E. Purkyně University, Masaryk Hospital, 401 13 Ústí nad Labem, Czech Republic
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Muacevic A, Adler JR. Implementation of National Emergency X-Radiography Utilization Study (NEXUS) Criteria in Pediatrics: A Systematic Review. Cureus 2022; 14:e30065. [PMID: 36238421 PMCID: PMC9547612 DOI: 10.7759/cureus.30065] [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] [Accepted: 10/08/2022] [Indexed: 11/05/2022] Open
Abstract
Since its introduction in 1992, the National Emergency X-Radiography Utilization Study (NEXUS) criteria have been used in trauma to decide whether a patient requires radiographic imaging. The tool is important in reducing radiation exposure. However, applying the NEXUS criteria for cervical spine imaging in pediatric patients is poorly supported compared to their use in adults. The objective of this review was to examine the effectiveness of using the NEXUS criteria in the diagnostic management of pediatric cervical spine injuries (CSI). The following databases were searched for studies focused on applying the NEXUS criteria for CSI in pediatric patients: Cochrane, PubMed, Google Scholar, EMBASE, ELSEVIER, and ScienceDirect. Additional studies were found through reference lists of primary sources and previous systematic and meta-analyses. The search focused on randomized controlled trials (RCTs), cohort studies, retrospective studies, prospective studies, and other uncontrolled trials published from 2000 to 2022. There were seven included studies with a total of 4502 pediatric patients. Five of the included studies were retrospective studies, while the remaining were prospective and case studies. Our results show that the sensitivity ranged from 43% to 100%, while the specificity ranged from 12.93% to 96%. The sensitivity increased with age, with those under the age of two or under the age of eight reporting poorer outcomes than the older pediatric patients. One study also shows that the proportion of patients undergoing cervical spine CT increased from 18% to 61% in the initial period before the implementation of clearance guidelines. The implementation of guidelines led to a 23% decrease in CT scans clearable by NEXUS criteria after 12 months. One of the studies reported that NEXUS criteria were a cost-effective option when used along with X-rays and CT. Overall, the studies do not strongly support the application of the NEXUS criteria to image pediatric patients for CSI. In conclusion, there is weak support in the literature for applying the NEXUS criteria in determining the need for cervical spine imaging in pediatric trauma patients. The practice and research implications of the findings are also discussed.
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9
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Pirruccio K, Shin M, Ganley TJ, Kelly JD, Parisien RL. Rock climbing confers distinct injury risk in pediatric versus adult populations: an analysis of twenty-year national trends. PHYSICIAN SPORTSMED 2022; 50:343-348. [PMID: 34029496 DOI: 10.1080/00913847.2021.1932631] [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] [Indexed: 09/30/2022]
Abstract
OBJECTIVES The sport of rock climbing has recently gained in popularity due in part to its adoption by noncompetitive athletes as a physical activity with a level of intensity that can be self-regulated. However, the epidemiology of rock climbing injuries is poorly described at the national level. METHODS We report demographic and injury characteristics from 85,235 national weighted estimates of rock climbing injuries presenting to United States (US) emergency departments (EDs) between 2000 and 2019 in the National Electronic Injury Surveillance System, stratifying by whether patients were ≤18 years of age (A) or ≥19 years of age (B). RESULTS The national weighted estimate of patients presenting to US EDs with injuries associated with rock climbing rose significantly (p < 0.001) from 2000 (2,667, CI 1,777-3,557) to 2019 (7,087, CI 4,544-9,630). Patients ≤18 years of age were significantly less likely to be male (A: 56.3%, CI 52.0-60.6%; B: 64.7%; CI 60.4-69.0%; p = 0.003), sustain injuries on weekends (A: 29.8%, 24.5-35.1%; B: 64.7%, CI 60.4-69.0%; p = 0.002), or sustain injuries during summer seasons (A: 26.6%, CI 22.1-31.1%; B: 33.2%, CI 28.1-38.3%; p = 0.049). Multivariate logistic regression demonstrated that patients ≤18 years of age were significantly more likely to present to EDs with head and neck (OR: 1.52, CI 1.04-2.21; p = 0.032) or upper extremity (OR: 1.55; CI 1.24-1.93; p < 0.001) injuries associated with rock climbing. CONCLUSION We identified a significant increase in the annual estimated number of patients presenting to US EDs with rock climbing injuries compared to what has previously been reported. As the number of climbers continues to grow, standardized safety policies may be implemented that specifically target injury mechanisms and patterns unique to both adult and pediatric populations.
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Affiliation(s)
- Kevin Pirruccio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Max Shin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Theodore J Ganley
- Department of Orthopaedic Surgery, The Children's Hospital of Philadelphia, Philadelphia, Pennylvania
| | - John D Kelly
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Robert L Parisien
- Department of Orthopaedic Surgery, Harvard Medical School and Boston Children's Hospital, Boston, USA
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Zeng J, Jiang H, Zhuo Y, Xu Y, Deng Z. A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury. Medicine (Baltimore) 2022; 101:e29717. [PMID: 35905208 PMCID: PMC9333534 DOI: 10.1097/md.0000000000029717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE This study describes an 8-year-old boy with a C2 fracture and dislocation with a left C2-C3 articular process interlocking and spinal cord injury who underwent open reduction and internal fixation using the posterior cervical approach and achieved satisfactory results. PATIENT CONCERNS An 8-year-old boy underwent an emergency transfer from a previous hospital after a car accident. DIAGNOSES Axial fracture and dislocation with spinal cord injury (American Spinal Injury Association grade C), traumatic shock, brain contusion, intracranial hemorrhage, mandibular fracture, pulmonary contusion and hemorrhage, left vertebral artery stenosis, and multiple fractures throughout the body. Radiological examination revealed a fracture of the lower edge of the C2 vertebral body, fourth-degree anterior spondylolisthesis of the C2 vertebral body, interlocking of the left C2-C3 articular processes, widening of the C2-C3 vertebral space, and occlusion of the V1 and 2 segments of the left vertebral artery. INTERVENTIONS The boy was immediately intubated and transferred to the pediatric intensive care unit for rescue treatment. However, the reduction was unsuccessful with 2 weeks of cranial traction. Thus, an open reduction was performed under general anesthesia. One month after the surgery, the boy was discharged from the hospital on foot after rehabilitation treatment. OUTCOMES The boy was discharged from the hospital 1 month after surgery. At the 8-month follow-up, a radiological examination showed that the corrected C2 vertebral body fracture and dislocation were satisfactorily reduced, and the spinal cord was adequately decompressed. The internal fixation position was also good, and the spinal sequence had recovered well. In summary, except for the muscle strength of the right upper limb, which was slightly worse, the other clinical symptoms were significantly improved. LESSONS In treating cervical fracture and dislocation with unilateral facet lock, the posterior open reduction of pedicle screw and lateral mass screw internal fixation achieved satisfactory results. Consequently, treating complex cervical spine injuries in children requires an accurate diagnosis and careful treatment strategy.
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Affiliation(s)
- Jiayu Zeng
- School of Clinical Medicine, Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China
| | - Hua Jiang
- Department of Pediatric Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China
| | - Yingquan Zhuo
- Department of Pediatric Surgery, Affiliated Hospital of Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China
| | - Yongkang Xu
- The Second Affiliated Hospital of Nanchang University, Nanchang University, Nanchang City, Jiangxi Province, People’s Republic of China
| | - Zhigang Deng
- School of Clinical Medicine, Guizhou Medical University, Guiyang City, Guizhou Province, People’s Republic of China
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11
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Janjua MB, Passias PG, Ray WZ. Critical appraisal of bibliometric study on most influential publications of upper cervical spine instability. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:190-192. [PMID: 35875620 PMCID: PMC9263730 DOI: 10.21037/jss-22-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/06/2022] [Indexed: 06/15/2023]
Affiliation(s)
- M. Burhan Janjua
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Peter G. Passias
- Department of Orthopedic Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Wilson Z. Ray
- Department of Neurological Surgery, Washington University School of Medicine, St. Louis, MO, USA
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12
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Richards A, Dadnam C, Murch HK. How to interpret spinal imaging in paediatric trauma. Arch Dis Child Educ Pract Ed 2022; 107:105-112. [PMID: 33637582 DOI: 10.1136/archdischild-2020-321110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 11/03/2022]
Abstract
Spinal injuries in children are fortunately rare; however, it is important that they are assessed and managed in a timely manner. A systematic approach to traumatic spinal injuries should be used, by following recent evidence and national protocols, in order to avoid misinterpretation and potentially, inappropriate discharge. The aim of this article is to highlight the concepts of spinal imaging in paediatric trauma with regards to indications, interpretation and limitations.
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Affiliation(s)
- Alexandra Richards
- Paediatric emergency department, Cardiff University School of Medicine, Cardiff, UK.,Paediatric Emergency Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Christopher Dadnam
- Paediatric Emergency Medicine, Cardiff and Vale University Health Board, Cardiff, UK
| | - Hannah Kate Murch
- Paediatric Emergency Medicine, Cardiff and Vale University Health Board, Cardiff, UK
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13
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Mistry D, Munjal H, Ellika S, Chaturvedi A. Pediatric spine trauma: A comprehensive review. Clin Imaging 2022; 87:61-76. [DOI: 10.1016/j.clinimag.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 03/26/2022] [Accepted: 04/21/2022] [Indexed: 11/03/2022]
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14
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O'Neill C, Wenzel A, Walterscheid Z, Carmouche J. Distinguishing Pseudosubluxation From True Injury: A Case of C2-3 and C3-4 Subluxation in a Pediatric Patient. J Am Acad Orthop Surg Glob Res Rev 2021; 5:01979360-202112000-00002. [PMID: 34860729 DOI: 10.5435/jaaosglobal-d-20-00238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/08/2021] [Indexed: 06/13/2023]
Abstract
A 6-year-old girl presented with a one-week history of neck pain after a trampoline accident. Cervical radiographs interpreted as pseudosubluxation of C2 on C3. CT demonstrated the reversal of lordosis with anterolisthesis of C2-C3 and C3-C4. Ten weeks after two months of halo traction, radiographs demonstrated anatomic alignment and maintained disk heights. This case highlights the similarities of pseudosubluxation and true injury, emphasizing the need for high index of suspicion in this population and a successful treatment of subluxation using a halo construct.
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Affiliation(s)
- Conor O'Neill
- From the Virginia Commonwealth University Department of Orthopaedics, Richmond, VA (Dr. O'Neill); Virginia Tech Carilion School of Medicine, Roanoke, VA (Ms. Wenzel and Dr. Carmouche); University of Washington Department of Orthopaedic and Sports Medicine, Seattle, WA (Dr. Walterscheid); and Carilion Clinic Department of Orthopaedics, Roanoke, VA (Dr. Carmouche)
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Elsamadicy AA, Sandhu MR, Freedman IG, Koo AB, Hengartner AC, Reeves BC, Havlik J, Sarkozy M, Hong CS, Kundishora AJ, Tuason DA, DiLuna M. Racial Disparities in Health Care Resource Utilization After Pediatric Cervical and/or Thoracic Spinal Injuries. World Neurosurg 2021; 156:e307-e318. [PMID: 34560297 DOI: 10.1016/j.wneu.2021.09.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 09/10/2021] [Accepted: 09/11/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to investigate the impact of race on hospital length of stay (LOS) and hospital complications among pediatric patients with cervical/thoracic injury. METHODS A retrospective cohort was performed using the 2017 admission year from 753 facilities utilizing the National Trauma Data Bank. All pediatric patients with cervical/thoracic spine injuries were identified using the ICD-10-CM diagnosis coding system. These patients were segregated by their race, non-Hispanic white (NHW), non-Hispanic black (NHB), non-Hispanic Asian (NHA), and Hispanic (H). Demographic, hospital variable, hospital complications, and LOS data were collected. A linear and logistic multivariate regression analysis was performed to determine the risk ratio for hospital LOS as well as complication rate, respectively. RESULTS A total of 4,125 pediatric patients were identified. NHB cohort had a greater prevalence of cervical-only injuries (NHW: 37.39% vs. NHB: 49.93% vs. NHA: 34.29% vs. H: 38.71%, P < 0.001). While transport accident was most common injury etiology for both cohorts, NHB cohort had a greater prevalence of assault (NHW: 1.53% vs. NHB: 17.40% vs. NHA: 2.86% vs. H: 6.58%, P < 0.001) than the other cohorts. Overall complication rates were significantly higher among NHB patients (NHW: 9.39% vs. NHB: 15.12% vs. NHA: 14.29% vs. H: 13.60%, P < 0.001). Compared with the NHW cohort, NHB, NHA, and H had significantly longer hospital LOS (NHW: 6.15 ± 9.03 days vs. NHB: 9.24 ± 20.78 days vs. NHA: 9.09 ± 13.28 days vs. H: 8.05 ± 11.45 days, P < 0.001). NHB race was identified as a significant predictor of increased LOS on multivariate regression analysis (risk ratio: 1.14, 95% confidence interval: 0.46, 1.82; P = 0.001) but not hospital complications (P = 0.345). CONCLUSIONS Race may significantly impact health care resource utilization following pediatric cervical/thoracic spinal trauma.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
| | - Mani R Sandhu
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Isaac G Freedman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Astrid C Hengartner
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - John Havlik
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Margot Sarkozy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chris S Hong
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dominick A Tuason
- Department of Orthopedics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michael DiLuna
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
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Sawarkar DP, Singh PK, Agrawal D, Gupta DK, Satyarthee GD, Doddamani R, Verma S, Meena R, Tandon V, Gurjar HK, Jagdevan A, Kumar R, Chandra PS, Kale SS. Anterior Odontoid Screw Fixation for Pediatric and Adolescent Odontoid Fractures: Single-Center Experience Over a Decade. World Neurosurg 2021; 153:e153-e167. [PMID: 34166831 DOI: 10.1016/j.wneu.2021.06.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Management of pediatric odontoid fractures is tricky and controversial. This study will enrich world literature with intricacies of anterior odontoid screw (OS) fixation in the pediatric population learned over the last decade. METHODS In this retrospective study, all patients with pediatric odontoid fracture who underwent anterior odontoid screw fixation from January 2010 to December 2019 were included and evaluated for surgical outcome. RESULTS Thirteen patients were included in this study (mean age, 15 years; range, 6-18 years; male/female, 11:2; type II, 10; type IIA, 1; type III, 2). Common causes of injury were motor vehicle accidents (61.5%) followed by fall from height (38.5%) and all were acute fractures (2-30 days). Five patients had neurologic deficits. Accurate placement of screw was achieved in 92.3% of patients, including all 9 patients who used intraoperative O-arm. K wire migration during bicortical drilling resulted in neurovascular injury, with 1 mortality (7.7%). The remaining 12 patients were available for follow-up (mean, 36 months; range, 20-72 months) and all had preservation of neck movements. Successful OS fixation was achieved in 84.6% of patients, including 1 patient (7.7%) who had a fibrous union. One patient (8.3%) had nonunion because of migration of the screw head in the C2 body. CONCLUSIONS Anterior odontoid screw fixation in the pediatric population provides good functional outcomes with instant fixation by direct osteosynthesis. However, the surgeon should be meticulous in the surgical approach and should achieve a lag effect. The surgeon should stop after engaging the outer cortex of the odontoid peg with K wire to avoid cranial migration. Intraoperative O-arm guidance is useful.
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Affiliation(s)
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Kumar Gupta
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Guru Dutta Satyarthee
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ramesh Doddamani
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Satish Verma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Meena
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Hitesh Kumar Gurjar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amandeep Jagdevan
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Kumar
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - P Sarat Chandra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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Fiester P, Rao D, Soule E, Patel J, Jenson M. "Supradental space sign" on cervical spine CT-a sign of tectorial membrane injury in adults trauma patients. Emerg Radiol 2021; 28:903-910. [PMID: 33988749 DOI: 10.1007/s10140-021-01940-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/03/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE The supradental space is a small, predominantly fat-filled recess superior to the atlanto-axial joint and inferior to the basion of the clivus that contains a small venous plexus. The posterior boundary of the supradental space is formed by the tectorial membrane, a stabilizing ligament of the craniocervical junction. The purpose of our study was to examine the imaging appearance of the supradental space in patients with tectorial membrane injury. MATERIALS AND METHODS Adult patients with tectorial membrane injury were identified utilizing keyword searches of radiology reports using Nuance mPower software. Age-matched positive and negative control groups were obtained. Two CAQ-certified neuroradiologists evaluated the cervical CT exams of these patients for supradental fat pad effacement from hematoma formation. The integrity of the osteoligamentous structures of the craniocervical junction was recorded on CT and MRI exams along with demographic information, clinical history, surgical management, and global outcome. Statistical analysis was performed. RESULTS Sixteen adults were diagnosed with tectorial membrane injury on cervical MRI. All patients with a visible supradental space demonstrated fat pad effacement and Hounsfield units consistent with hematoma formation. The positive and negative control groups demonstrated supradental fat pad effacement in 2/16 and 1/16 patients, respectively. A p-value of < 0.001 was obtained. CONCLUSION The "supradental space sign," defined as hematoma formation in the supradental space with effacement of the supradental fat pad is associated with tectorial membrane injury in adult trauma patients with sensitivity of 93.75% (95% confidence interval 69.77 to 99.84%) and specificity of 90.62% (95% confidence interval 74.98 to 98.02%).
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Affiliation(s)
- Peter Fiester
- Department of Neuroradiology, University of Florida Health-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA.
| | - Dinesh Rao
- Department of Neuroradiology, University of Florida Health-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA
| | - Erik Soule
- Department of Neuroradiology, University of Florida Health-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA
| | - Jeet Patel
- Department of Neuroradiology, University of Florida Health-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA
| | - Matthew Jenson
- Department of Neuroradiology, University of Florida Health-Jacksonville, 655 West 8th Street, Jacksonville, FL, 32209, USA
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Kim SK, Chang DG, Park JB, Seo HY, Kim YH. Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report. Medicine (Baltimore) 2021; 100:e25588. [PMID: 33879718 PMCID: PMC8078422 DOI: 10.1097/md.0000000000025588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/31/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. PATIENT CONCERNS A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. DIAGNOSIS Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. INTERVENTIONS The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. OUTCOMES At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. LESSONS To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.
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Affiliation(s)
- Sung-Kyu Kim
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Inje University Sanggye Paik Hospital, College of Medicine, Inje University
| | - Jong-Beom Park
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyoung-Yeon Seo
- Department of Orthopaedic Surgery, Chonnam National University Medical School and Hospital, Gwangju
| | - Yun Hwan Kim
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Konovalov N, Peev N, Zileli M, Sharif S, Kaprovoy S, Timonin S. Pediatric Cervical Spine Injuries and SCIWORA: WFNS Spine Committee Recommendations. Neurospine 2020; 17:797-808. [PMID: 33401857 PMCID: PMC7788416 DOI: 10.14245/ns.2040404.202] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/07/2020] [Indexed: 11/19/2022] Open
Abstract
Cervical trauma in children have variations from the adults mainly due to anatomic differences. An optimal diagnostic and treatment strategy is critical, particularly when there is a lack of standardized protocols for the management of such cases. This review paper examines the diagnostic and treatment options of pediatric cervical trauma and Spinal Cord Injury Without Radiographic Abnormality (SCIWORA). A literature search for the last 10 years were conducted using key words. Case reports, experimental studies, papers other than English language were excluded. Up-to-date information on pediatric cervical trauma and SCIWORA were reviewed and statements were produced to reach a consensus in 2 separate consensus meeting of WFNS Spine Committee. The statements were voted and reached a consensus using Delphi method. This review reflects different aspects of contemporary pediatric cervical trauma decision-making and treatment, and SCIWORA. The mainstay of SCIWORA treatment is nonsurgical with immobilization, avoidance of risky activities. Prognosis generally depends on the initial neurological status and magnetic resonance imaging. Due to a significant discrepancy in the literature on diagnostic and management, future randomized controlled trials are needed to aid in generating standardized protocols.
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Affiliation(s)
- Nikolay Konovalov
- Burdenko Institute Department of Neurosurgery, Moscow, Russian Federation
| | - Nikolay Peev
- Department of Neurosurgery, Belfast Health and Social Care Trust, Northern Ireland, Belfast, UK
| | - Mehmet Zileli
- Department of Neurosurgery, Ege University, Izmir, Turkey
| | - Salman Sharif
- Neurosurgery Liaquat National Hospital & Medical College, Karachi Pakistan, Karachi, Pakistan
| | - Stanislav Kaprovoy
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
| | - Stanislav Timonin
- Burdenko National Medical Research Center of Neurosurgery, Moscow, Russian Federation
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20
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Patterns of pediatric cervical spine fractures in association with mandibular and facial fractures. Int J Pediatr Otorhinolaryngol 2020; 139:110428. [PMID: 33049552 DOI: 10.1016/j.ijporl.2020.110428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/03/2020] [Accepted: 10/03/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the incidence, demographics, and outcomes of concurrent cervical spine (C-spine) fractures in pediatric facial trauma. METHODS The Kids' Inpatient Database (KID) from the 2016 Healthcare Cost Utilization Project (HCUP) was queried for various facial fractures using International Classification of Diseases Tenth Revision (ICD-10) diagnosis codes. Mandible fractures were further subdivided into fracture site. Patients aged 0-18 were included, and rates of C-spine fracture were analyzed with regards to demographic factors, length of stay, total charges, mortality rate, hospital characteristics, and concurrent facial fractures. RESULTS Of 5568 patients included, 4.18% presented with C-spine fracture. Children with C-spine fractures were significantly older (15.02 vs 12.76 years, p < 0.001) and length of stay was significantly longer (11.33 vs 6.44 days, p < 0.001). There was no difference in rate of C-spine fracture when stratified by gender, time of week/year, hospital location/type, or facial fracture other than subcondylar fractures. Subcondylar fractures were positively associated with C-spine fractures (OR 2.08, p = 0.002). C-spine fractures were associated with significantly higher mortality, length of stay, rate of tracheostomy, transfer out of index hospital, and total hospital charges. CONCLUSIONS A significant association exists between subcondylar mandible and C-spine fractures. Awareness of this information is vital for clinicians who manage pediatric facial trauma and alerts them to the need to rule out C-spine fractures in this group as these patients have significantly higher lengths of stay, total mean hospital costs, mortality and tracheostomy rates.
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21
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Oshlag B, Ray T, Boswell B. Neck Injuries. Prim Care 2020; 47:165-176. [PMID: 32014132 DOI: 10.1016/j.pop.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neck injuries are relatively uncommon but have the potential to cause serious and permanent disability. In athletes, injuries are most common in contact sports, and occur with direct axial loading with a forward-flexed neck. Soft tissue and peripheral nerve injuries are typically minor and self-limiting, with excellent recovery potential and return to activities based on symptoms. Concern for devastating spinal cord injuries has led to routine immobilization using spine boards and hard cervical collars. This approach may provide more harm than benefit when applied universally, and a more commonsense protocol can be used to better address potential neck injuries.
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Affiliation(s)
- Benjamin Oshlag
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, First Ave at 16th St, New York, NY 10003, USA.
| | - Tracy Ray
- Duke Sports Medicine, Duke University, 3475 Erwin Rd, Durham, NC 27705, USA
| | - Benjamin Boswell
- Dvision of Sports Medicine, Primary Care Sports Medicine, Department of Orthopedic Surgery, Department of Emergency Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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22
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Katar S, Aydin Ozturk P, Ozel M, Cevik S, Evran S, Baran O, Akkaya E, Asena M, Cetin A. Pediatric Spinal Traumas. Pediatr Neurosurg 2020; 55:86-91. [PMID: 32580195 DOI: 10.1159/000508332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Although childhood trauma is a major cause of morbidity and mortality, the incidence of spinal trauma is significantly lower in children than in adults. Existing studies on pediatric spinal trauma (PST) largely concern cervical trauma because of its frequency of incidence. We aimed to obtain more information by examining all types of spinal trauma, and evaluating factors such as age, trauma type, injury type, and American Spinal Injury Association score and comparing them with data from the literature. METHODS We retrospectively reviewed 30 pediatric trauma patients with spinal pathology confirmed by spinal imaging. RESULTS The mean age was 166.4 months. Mean age for each mechanism of injury was: 142.7 months for a simple fall, 149.0 months for injury involving a foreign object, 163.5 months for a fall from a height, and 181.6 months for traffic accidents. There was no statistically significant difference in mean age for different mechanisms of injury (p = 0.372). The levels of the spinal injuries were: lumbar 53.3% (16), thoracic 26.6% (8), and cervical 20.0% (6). Mean age for each level of spinal injury was 113.3 months for the cervical area, 172.2 months for the thoracic area, and 183.3 months for the lumbar area. Mean age was found to be statistically significant (p = 0.000). DISCUSSION PST is uncommon and the type of trauma and the spinal level affected varies with age. Cervical trauma predominates at younger ages, but adult-like traumas begin to occur with increasing age. It should be considered that the risk of developing neurological deficits is higher in pediatric patients than in adults, and the risk of multisystem injury is also high.
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Affiliation(s)
- Salim Katar
- Department of Neurosurgery, Balikesir University, Balikesir, Turkey
| | - Pinar Aydin Ozturk
- Department of Neurosurgery, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey,
| | - Mehmet Ozel
- Department of Emergency Medicine, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
| | - Serdar Cevik
- Department of Neurosurgery, Memorial Sisli Hospital, Istanbul, Turkey
| | - Sevket Evran
- Department of Neurosurgery, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Oguz Baran
- Department of Neurosurgery, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Enes Akkaya
- Department of Neurosurgery, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
| | - Muhammet Asena
- Department of Pediatrics, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
| | - Abdurrahman Cetin
- Department of Neurosurgery, University of Health Sciences, Diyarbakır Gazi Yasargil Education and Research Hospital, Diyarbakır, Turkey
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Tectorial membrane injury in adult and pediatric trauma patients: a retrospective review and proposed classification scheme. Emerg Radiol 2019; 26:615-622. [PMID: 31352640 DOI: 10.1007/s10140-019-01710-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE Traumatic tectorial membrane injuries have different radiologic presentations in adult versus pediatric patients. The purpose of this study was to identify and classify the different types of tectorial membrane injuries that occur in the adult and pediatric populations. MATERIALS AND METHODS Patients who suffered tectorial membrane injury were identified retrospectively using the keywords 'tectorial membrane," "craniocervical ligament tear/injury," and "atlanto-occipital dissociation" included in radiology reports between 2012 and 2018 using Nuance mPower software. All relevant imaging studies were reviewed by two certificates of additional qualification-certified neuroradiologists. Detailed descriptions of injuries were recorded along with any relevant additional findings, including clinical history. RESULTS Ten adults and six pediatric patients were identified with acute traumatic injuries of the tectorial membrane. Ninety percent of the adult patients sustained complete disruptions inferior to the clivus, or subclival, with 22% of tears at the level of the basion and 78% at the level of the odontoid tip. In contrast, 83% of pediatric patients suffered a stripping injury of the tectorial membrane located posterior to the clivus, or retroclival. Stretch injuries of the tectorial membrane were identified in 10% of adults and 17% of pediatric patients. The juvenile-type injury, which causes retroclival epidural hematoma, was determined to preferentially occur in patients less than or equal to 14 years of age with a high level of statistical significance (p value = 0.0014). CONCLUSIONS A classification system for tectorial membrane injuries is proposed based on this data: type 1-retroclival stripping injury (more common in pediatric patients); type 2a-subclival disruption at the basion and type 2b-subclival disruption at the odontoid (both more common in adult patients); and type 3-thinning of the tectorial membrane.
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Agarwal A. Let's Give Our Best to the Children: The Pediatric Trauma Symposium. Indian J Orthop 2018; 52:447-448. [PMID: 30237600 PMCID: PMC6142792 DOI: 10.4103/ortho.ijortho_376_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Anil Agarwal
- Guest Editor, Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, India
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