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Castillo J, Soufi K, Zhou J, Kulubya E, Javidan Y, Ebinu JO. Minimally Invasive Techniques in the Surgical Management of Traumatic Pediatric Thoracolumbar Fractures. World Neurosurg 2024; 182:e292-e300. [PMID: 38008163 DOI: 10.1016/j.wneu.2023.11.102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
BACKGROUND Thoracolumbar (TL) fractures are uncommon in children. While surgical treatment is recommended for unstable TL fractures, there is no consensus on appropriate surgical treatment. We present a case series of pediatric patients with traumatic TL fractures treated with minimally invasive techniques. We discuss our early experience and technical challenges with navigation and robotic-assisted fixation. METHODS A retrospective review of a prospectively maintained trauma database from February 2018 to February 2023 of all pediatric patients (<18 years old) undergoing percutaneous fixation for unstable TL fractures was performed. Minimally invasive techniques included fluoroscopy and/or navigation-guided or robotic-assisted surgery. Clinical course, radiographic findings, and technical challenges were reviewed. RESULTS A cohort of 12 patients (age range, 4-17 years) with 6 (50%) Chance fractures, 2 (16%) pars fractures, 2 (16%) pedicle fracture, 1 (8%) burst fracture, and 1 (8%) other fracture were identified. Nine patients had fractures involving the lumbar spine, and the remaining 3 had thoracic fractures. In all cases, percutaneous pedicle screws were placed above and below the fracture with the use of neuronavigation or robotic-assisted navigation (n = 2). Blood loss was <30 mL for single-level fractures and instrumented fusion. Two patients had hardware-related complications. At follow-up (mean 9.67 months after surgery), patients were doing well clinically, and most imaging showed stable alignment. CONCLUSIONS Our early experience shows that short segment instrumentation through a minimally invasive approach is a safe and effective surgical option for young pediatric patients with good clinical outcomes and favorable radiographic postoperative finding.
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Affiliation(s)
- Jose Castillo
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - Khadija Soufi
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - James Zhou
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - Edwin Kulubya
- Department of Neurological Surgery, University of California, Sacramento, California, USA
| | - Yashar Javidan
- Department of Orthopedic Surgery, University of California, Sacramento, California, USA
| | - Julius O Ebinu
- Department of Surgery, Division of Neurosurgery, Queen's University, Kingston, Ontario, Canada.
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Luckhurst CM, Wiberg HM, Brown RL, Bruch SW, Chandler NM, Danielson PD, Draus JM, Fallat ME, Gaines BA, Haynes JH, Inaba K, Islam S, Kaminski SS, Kang HS, Madabhushi VV, Murray J, Nance ML, Qureshi FG, Rubsam J, Stylianos S, Bertsimas DJ, Masiakos PT. Pediatric Cervical Spine Injury Following Blunt Trauma in Children Younger Than 3 Years: The PEDSPINE II Study. JAMA Surg 2023; 158:1126-1132. [PMID: 37703025 PMCID: PMC10500431 DOI: 10.1001/jamasurg.2023.4213] [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: 04/11/2023] [Accepted: 06/16/2023] [Indexed: 09/14/2023]
Abstract
Importance There is variability in practice and imaging usage to diagnose cervical spine injury (CSI) following blunt trauma in pediatric patients. Objective To develop a prediction model to guide imaging usage and to identify trends in imaging and to evaluate the PEDSPINE model. Design, Setting, and Participants This cohort study included pediatric patients (<3 years years) following blunt trauma between January 2007 and July 2017. Of 22 centers in PEDSPINE, 15 centers, comprising level 1 and 2 stand-alone pediatric hospitals, level 1 and 2 pediatric hospitals within an adult hospital, and level 1 adult hospitals, were included. Patients who died prior to obtaining cervical spine imaging were excluded. Descriptive analysis was performed to describe the population, use of imaging, and injury patterns. PEDSPINE model validation was performed. A new algorithm was derived using clinical criteria and formulation of a multiclass classification problem. Analysis took place from January to October 2022. Exposure Blunt trauma. Main Outcomes and Measures Primary outcome was CSI. The primary and secondary objectives were predetermined. Results The current study, PEDSPINE II, included 9389 patients, of which 128 (1.36%) had CSI, twice the rate in PEDSPINE (0.66%). The mean (SD) age was 1.3 (0.9) years; and 70 patients (54.7%) were male. Overall, 7113 children (80%) underwent cervical spine imaging, compared with 7882 (63%) in PEDSPINE. Several candidate models were fitted for the multiclass classification problem. After comparative analysis, the multinomial regression model was chosen with one-vs-rest area under the curve (AUC) of 0.903 (95% CI, 0.836-0.943) and was able to discriminate between bony and ligamentous injury. PEDSPINE and PEDSPINE II models' ability to identify CSI were compared. In predicting the presence of any injury, PEDSPINE II obtained a one-vs-rest AUC of 0.885 (95% CI, 0.804-0.934), outperforming the PEDSPINE score (AUC, 0.845; 95% CI, 0.769-0.915). Conclusion and Relevance This study found wide clinical variability in the evaluation of pediatric trauma patients with increased use of cervical spine imaging. This has implications of increased cost, increased radiation exposure, and a potential for overdiagnosis. This prediction tool could help to decrease the use of imaging, aid in clinical decision-making, and decrease hospital resource use and cost.
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Affiliation(s)
- Casey M. Luckhurst
- Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston
| | | | - Rebeccah L. Brown
- Division of Pediatric Surgery at Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Steven W. Bruch
- Division of Pediatric Surgery at University of Michigan Medical Center, Ann Arbor
| | - Nicole M. Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - Paul D. Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children’s Hospital, St Petersburg, Florida
| | - John M. Draus
- Division of Pediatric Surgery at Kentucky Children’s Hospital, Lexington
| | - Mary E. Fallat
- Division of Pediatric Surgery at Norton Children’s Hospital, Louisville, Kentucky
| | - Barbara A. Gaines
- Division of Pediatric Surgery at University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jeffrey H. Haynes
- Department of Pediatric Surgery, Children’s Hospital of Richmond at Virginia Commonwealth University Health, Richmond
| | - Kenji Inaba
- Division of Trauma, Emergency Surgery, and Surgical Critical Care at University of Southern California Medical Center, Los Angeles
| | - Saleem Islam
- Division of Pediatric Surgery at University of Florida Health, Gainesville
| | - Stephen S. Kaminski
- Department of Surgery at Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Hae Sung Kang
- Department of Surgery, Virginia Commonwealth University Health, Richmond
| | | | - Jason Murray
- Department of Surgery, University of Texas Health Tyler, Tyler
| | - Michael L. Nance
- Division of Pediatric Surgery at Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Faisal G. Qureshi
- Division of Pediatric Surgery at Children’s Medical Center Dallas, Dallas, Texas
| | - Jeanne Rubsam
- Division of Pediatric Surgery at Morgan Stanley Children’s Hospital of New York-Presbyterian, New York
| | - Steven Stylianos
- Division of Pediatric Surgery at Morgan Stanley Children’s Hospital of New York-Presbyterian, New York
| | | | - Peter T. Masiakos
- Division of Pediatric Surgery, Massachusetts General Hospital, Boston
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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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ÖZBEY Ö, ARSLAN FZ, KÖREZ MK, PAYASLI M. Do we know the normal anterior-posterior diameters of the spinal cord and canal in newborns? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2023. [DOI: 10.32322/jhsm.1215575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023] Open
Abstract
Aim: We aim to reveal the normal anterior-posterior diameter of the spinal cord and canal at cervical, thoracic and lumbar levels in newborn with sonographic measurements and to create a reference value. Also, we aim to reveal whether the anterior-posterior diameter at these levels will vary with the newborn's head circumference, gender, height and weight. Thus, we aim to be one of the pioneering studies in the literature
Material and Method: Statistical analysis was performed to determine normal anterior-posterior diameter for the spinal canal and spinal cord at each vertebral level, and their correlations with birth weight, length and head circumference.
Results: 188 newborns were included. The mean anteroposterior spinal canal diameter in male newborns was significantly higher compared to females (9.27±0.83 vs 9.00±0.79, p=.020). There was a positive correlation between spinal cord anterior-posterior diameter and head circumference at thoracic level, which was statistically significant. There was a positive correlation between spinal canal diameter and height at thoracic level. There was a positive correlation between spinal canal diameter and weight at lumbar level.
Conclusion: The establishment of the normal values for anterior-posterior diameters of the spinal cord in healthy newborns may contribute the current literature data.
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Affiliation(s)
- Öner ÖZBEY
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYOLOJİ ANABİLİM DALI
| | - Fatma Zeynep ARSLAN
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ, DAHİLİ TIP BİLİMLERİ BÖLÜMÜ, RADYOLOJİ ANABİLİM DALI
| | | | - Müge PAYASLI
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL BAŞAKŞEHİR ÇAM VE SAKURA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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Kalanjiyam GP, Kanna RM, Rajasekaran S. Pediatric spinal injuries- current concepts. J Clin Orthop Trauma 2023; 38:102122. [PMID: 36846073 PMCID: PMC9945789 DOI: 10.1016/j.jcot.2023.102122] [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: 01/03/2023] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Spinal injuries in children contribute to the highest mortality and morbidity among all pediatric injuries. Fortunately, these injuries are a rare clinical entity but pose a difficulty in diagnosis due to challenges in neurological evaluation of a child and varied radiological presentation. Anatomical and biomechanical aspects of developing musculoskeletal system, relative plasticity of the pediatric spine make children vulnerable to spine injuries. Though motor vehicle collisions are common, children also suffer non-accidental trauma, falls and sports injuries. More chances of cervical spine involvement, higher susceptibility of spinal cord to tensile forces and associated multisystem injuries result in devastating consequences in children compared to adults. Injuries like SCIWORA, vertebral apophyseal injuries, birth-related spinal cord injuries are more specific injuries in pediatric age group. A vigilant clinical, neurological and radiological evaluation is mandatory in all children with suspected spinal injuries. Normal radiological features like ossification centers, pseudosubluxation and physiological vertebral wedging should be carefully noted as they could be misinterpreted as injuries. While CT scans help in better understanding of the fracture pattern, Magnetic Resonance Imaging in children is beneficial especially in detecting SCIWORA and other soft tissue injuries. Management principles of these pediatric spinal injuries are similar to adults. Literature evidences support conservative management in injuries like SCIWORA, unless there is an ongoing spinal cord compression. As in adults, the role of high dose methylprednisolone is still controversial in pediatric spinal cord injuries. Stable spinal injuries can be managed conservatively using orthosis or halo. Instrumentation by both anterior and posterior techniques has been described, but it is challenging due to smaller anatomy and poor implant purchase. In addition to pedicle screw instrumentation, wiring techniques are very beneficial especially in younger children.
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Affiliation(s)
| | - Rishi Mugesh Kanna
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
| | - S. Rajasekaran
- Department of Spine Surgery, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, India
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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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Thomas AX, Riviello JJ, Davila-Williams D, Thomas SP, Erklauer JC, Bauer DF, Cokley JA. Pharmacologic and Acute Management of Spinal Cord Injury in Adults and Children. Curr Treat Options Neurol 2022; 24:285-304. [PMID: 35702419 PMCID: PMC9184374 DOI: 10.1007/s11940-022-00720-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/26/2022]
Abstract
Purpose of Review This review provides guidance for acute spinal cord injury (SCI) management through an analytical assessment of the most recent evidence on therapies available for treating SCI, including newer therapies under investigation. We present an approach to the SCI patient starting at presentation to acute rehabilitation and prognostication, with additional emphasis on the pediatric population when evidence is available. Recent Findings Further studies since the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS) demonstrated a potential functional outcome benefit with ultra-early surgical intervention ≤ 8 h post-SCI. Subsequent analysis of the National Acute Spinal Cord Injury Study (NASCIS) II and NASCIS III trials have demonstrated potentially serious complications from intravenous methylprednisolone with limited benefit. Newer therapies actively being studied have demonstrated limited or no benefit in preclinical and clinical trials with insufficient evidence to support use in acute SCI treatment. Summary Care for SCI patients requires a multi-disciplinary team. Immediate evaluation and management are focused on preventing additional injury and restoring perfusion to the affected cord. Rapid assessment and intervention involve focused neurological examination, targeted imaging, and surgical intervention when indicated. There are currently no evidence-based recommendations for pathomechanistically targeted therapies.
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Affiliation(s)
- Ajay X. Thomas
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Jan and Dan Duncan Neurological Research Institute, Texas Children’s Hospital, Houston, TX USA
| | - James J. Riviello
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Daniel Davila-Williams
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - Sruthi P. Thomas
- Division of Pediatric Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX USA
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Jennifer C. Erklauer
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
| | - David F. Bauer
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Baylor College of Medicine, Houston, TX USA
| | - Jon A. Cokley
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Department of Pharmacy, Baylor College of Medicine, Houston, TX USA
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Hasan S, Waheed M, Suhrawardy AK, Braithwaite C, Ahmed L, Zakko P, Khalil JG, Saleh ES. Pediatric Upper Cervical Spine Trauma: A 10-Year Retrospective Review at a Pediatric Trauma Center. Cureus 2022; 14:e20995. [PMID: 35028239 PMCID: PMC8751658 DOI: 10.7759/cureus.20995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background Traumatic upper cervical spine injuries (tUCSI) are generally caused by high-impact injuries to the C1-C2 vertebral level. The current literature is limited with regards to comparing epidemiological trends, treatment options, and overall outcomes for tUCSI within the pediatric cohort. The purpose of this study was to analyze pediatric tUCSI epidemiological data, potential variations in treatment and patient outcomes, and to evaluate any specific trends that may be clinically relevant. Methodology We conducted a retrospective cohort study on pediatric patients ages 1 day to 16 years old, admitted for tUCSI over the past 10 years (1/2011 to 1/2021) at a Midwest level 1 trauma center. Retrospective data was queried using ICD-9 and ICD-10 diagnosis codes for tUCSI. Children were stratified into three age groups: Group 1 - Infants and Toddlers (children under three years of age); Group 2 - Young Children (children between three and seven years of age); Group 3 - Juveniles and Adolescents (children between the ages of seven and 16). Numerical data and categorical variables were summarized and the normality of the distribution of data was evaluated using the Anderson-Darling normality test. Differences between the age groups were examined using either an unpaired, independent Two-Sample t-test or Unpaired Mann-Whitney U test. Pearson’s chi-squared or Fisher’s exact tests were used to compare categorical data between groups. Results Forty total patients were included in the final analysis, 23 female (57.5%) and 17 male (42.5%). The mean age was 11 ± 4 (range 2-16). Overall, the most common mechanism of injury was a motor vehicle collision (n=16, 40%), followed by sports injury (n=13, 32.5%), falls (n=6, 15%), and unknown mechanism (n=5, 12.5%). The most common mechanism of injury in young children was a fall (n=4, 57.5%, p<0.001). Adolescents and Juveniles significantly suffer from sports injuries compared to young children (n=13, 39.4%, p=0.043). Mechanisms of injuries presented with unique associated concomitant injuries. The most common associated sites of injuries were lower cervical spine (n=31, 77.5%), and skull injury (n=4, 10%). The vast majority of these cases were managed nonoperatively (pain medication and non-operative cervical orthosis) (n=36, 90%). Mortality and morbidity rates from tUCSI were rare in our cohort (n=1, 2.5%). Conclusion This study found that the majority of pediatric tUCSI patients can be managed nonoperatively, with dislocations and spinal instability being the most common indications for operative management. Commonly used non-operative external fixation methods include cervical collars and Minerva jackets. Our cohort showed very low mortality and morbidity rates, however, these preliminary results will require validation by future prospective multicenter studies.
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Massoumi R, Wertz J, Duong T, Tseng CH, Jen HCH. Variation in pediatric cervical spine imaging across trauma centers-A cause for concern? J Trauma Acute Care Surg 2021; 91:641-648. [PMID: 34238853 PMCID: PMC8460080 DOI: 10.1097/ta.0000000000003344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/22/2021] [Accepted: 06/24/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic pediatric cervical spine injury can be challenging to diagnose, and the clinical algorithms meant to aid physicians differ from adult trauma protocols. Despite the existence of standardized guidelines, imaging decisions may vary according to physician education, subjective assessment, and experience with pediatric trauma patients. Our study investigates the rates of pediatric posttraumatic cervical spine imaging across trauma centers, hypothesizing that more specialized centers will have lower rates of advanced cervical spine imaging. METHODS The 2015 to 2016 Trauma Quality Improvement Program database was reviewed for patients younger than 18 years- to assess rates of cervical spine imaging on presentation across different trauma centers. Propensity stratification logistic regression was performed controlling for patient- and center-specific variables. p Values less than 0.05 were considered significant. RESULTS Of 110,769 pediatric trauma patients, 35.2% were female, and the average age was 9.6 years. Overall, 3.6% had cervical spine computed tomography (CT) and less than 1% had cervical spine MRI or X-ray. Compared with all others, Level I trauma centers were significantly less likely to use cervical spine CT for the initial evaluation of younger (≤14 years) but not older trauma patients (adjusted odds ratio [AOR], 0.89; 95% confidence interval [CI], 0.80-0.99; AOR, 0.97; 95% CI, 0.87-1.09); Level I centers had higher odds of cervical spine MRI use, but only for patients 14 years or younger (AOR, 1.63; 95% CI, 1.09-2.44). Pediatric-designated trauma centers had significantly lower odds of cervical spine CT (≤14 years: AOR, 0.70; 95% CI, 0.63-0.78; >14 years: AOR, 0.67; 95% CI, 0.67-0.75) and higher odds of cervical spine X-ray (≤14 years: AOR, 4.75; 95% CI, 3.55-6.36; >14 years: AOR, 4.50; 95% CI, 2.72-7.45) for all ages, but higher odds of cervical spine MRI for younger patients only (≤14 years: AOR, 2.10; 95% CI, 1.38-3.21). CONCLUSION Level I and pediatric designations were associated with lower rates of cervical spine CT. Pediatric centers were also more likely to use cervical spine X-ray. This variability of imaging use further supports the need to disseminate and educate providers on pediatric-specific cervical spine evaluation guidelines. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
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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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11
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Dunbar DC, Vilensky JA, Suárez-Quian CA, Shen PY, Metaizeau JP, Supakul N. Risk factors for neonatal brachial plexus palsy attributed to anatomy, physiology, and evolution. Clin Anat 2021; 34:884-898. [PMID: 33904192 DOI: 10.1002/ca.23739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 02/07/2021] [Accepted: 03/01/2021] [Indexed: 11/11/2022]
Abstract
The inherent variable anatomy of the neonate and the uniquely-shaped maternal birth canal that is associated with the evolution of human bipedalism constitute risk factors for neonatal brachial plexus palsy (NBPP). For example, those neonates with a prefixed brachial plexus (BP) are at greater risk of trauma due to lateral neck traction during delivery than those with a normal or postfixed BP. Compared to adults, neonates also have extremely large and heavy heads (high head: body ratio) set upon necks with muscles and ligaments that are weak and poorly developed. Accordingly, insufficient cranial stability can place large torques on the cervical spinal nerves. In addition, the pelvic changes necessary for habitual bipedal posture resulted in a uniquely-shaped, obstruction-filled, sinusoidal birth canal, requiring the human fetus to complete a complicated series of rotations to successfully traverse it. Furthermore, although there are many risk factors that are known to contribute to NBPP, the specific anatomy and physiology of the neonate, except for macrosomia, is not considered to be one of them. In fact, currently, the amount of lateral traction applied to the neck during delivery is the overwhelming legal factor that is used to evaluate whether a birth attendant is liable in cases of permanent NBPP. Here, we suggest that the specific anatomy and physiology of the neonate and mother, which are clearly not within the control of the birth attendant, should also be considered when assessing liability in cases of NBPP.
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Affiliation(s)
- Donald C Dunbar
- Department of Electrical and Computer Engineering, San Diego State University, San Diego, California, USA
| | - Joel A Vilensky
- Department of Occupational Therapy, Huntington University, Fort Wayne, Indiana, USA
| | - Carlos A Suárez-Quian
- Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Peter Yi Shen
- Neuroradiology/Diagnostic Radiology, Kaiser Permanente, Santa Clara, California, USA.,Radiology, Neuroradiology, University of California, Davis, California, USA
| | | | - Nucharin Supakul
- Clinical Radiology & Imaging Science, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana, USA
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12
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Dou H, Xie C, Zhu S, Wang X, Huang Q, Zhou F. Feasibility analysis of the use of anterior screw fixation in the treatment of pediatric odontoid fracture. Transl Pediatr 2021; 10:967-972. [PMID: 34012844 PMCID: PMC8107875 DOI: 10.21037/tp-21-101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aimed to determine the feasibility of using anterior percutaneous screw fixation to treat odontoid fractures in children of different ages based on computed tomography (CT) measurements. METHODS A total of 176 children were enrolled and divided into 3 groups: group A (<6 years of age; 18 males and 22 females), group B (6 to 12 years old; 40 males and 35 females), and group C (12 to 18 years old; 34 males and 27 females). Using 2-dimensional CT reconstruction technology, we measured the children's odontoid parameters, including the coronal external diameter of the base of the odontoid process, the sagittal external diameter of the base of the odontoid process, the length of the odontoid process, the height of the axis vertebral body, and the angle between the axial line of the odontoid process and the vertical line of the anterosuperior border of the C3 vertebral body. RESULTS The mean coronal external diameter of the odontoid process base in children under 6 years old was 4.21±1.62 mm, which was not sufficient to accommodate a single screw. Among children aged 6 to 12 years old, this parameter varied widely, and the mean diameter was 5.50±2.80 mm. In the 12- to 18-year-old group, the diameter was 8.64±1.68 mm, which is similar to that of adults. The values of the total height of the axis, and the angle between the axial line of the and the vertical line of the anterosuperior C3 vertebral body border were lower than those for adults. CONCLUSIONS The percutaneous odontoid screw fixation technique is not recommended for children under 6 years old. For children aged 6 to 18 years old, this technique is feasible, but individual differences must be considered preoperatively. Selecting the appropriate screw diameter, length, and angle according to the actual CT measurement result is critical.
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Affiliation(s)
- Haicheng Dou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Chenglong Xie
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Sipin Zhu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Xiangyang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Qishan Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
| | - Feiya Zhou
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Zhejiang Spine Surgery Center, Zhejiang Provincial Key Laboratory of Orthopaedics, Wenzhou, China
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13
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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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14
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Mitchell A, Upasani VV, Bartley CE, Newton PO, Yaszay B. Rigid segmental cervical spine instrumentation is safe and efficacious in younger children. Childs Nerv Syst 2019; 35:985-990. [PMID: 30941509 DOI: 10.1007/s00381-019-04130-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/18/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE The utilization of cervical spine instrumentation in the young pediatric patient is not well reported. This study presents outcomes and complications of cervical spine instrumentation in patients who underwent cervical spine fusion surgery before age 10. METHODS Radiographic and clinical data were collected on all patients who underwent cervical spine surgery with instrumentation at a single institution between January 1, 2006, and March 31, 2015. Patients were ≤ 10 years of age at the time of surgery with any cervical spine deformity/injury diagnosis. Patient demographics, details on cervical spine diagnosis, procedural data, imaging data, and postoperative follow-up data were collected. RESULTS Twenty children met the criteria and were included in the study with a mean follow-up of 10.6 months (3 months-2 years). Initial indication for cervical spine correction surgery included deformity (7 cases), trauma (6 cases), instability (3 cases), stenosis (2 cases), rotary subluxation (1 case), and infection (1 case). Fifteen cases were treated with adult 3.5-mm cervical spine instrumentation, 3 with wiring (1 sublaminar and 2 spinous process), and 2 with cannulated screws. Postoperative immobilization included 16 halo fixation, 3 collars, and 1 CTO. Overall, there were five complications related to the surgery. Two patients who had wiring (1 sublaminar and 1 spinous process) developed a non-union and required revision surgery (1 with cannulated screws and 1 with 3.5-mm segmental cervical spine instrumentation). One patient developed a postoperative infection that required incision and drainage. Five patients developed superficial pin infections for their halo. Two deformity patients experienced neurological complications that were likely unrelated to the cervical instrumentation. CONCLUSIONS Rigid segmental fixation can be safe and efficacious when used in pediatric cervical spine patients. Whether used with halo or orthosis, patients experience minimal to no complications from the instrumentation and achieve successful fusion. Cervical spine wiring had a high risk of non-union requiring revision surgery. The incidence of wound infection was low with one in 20 cases.
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Affiliation(s)
- Ana Mitchell
- University of California San Diego, San Diego, CA, USA
| | - Vidyadhar V Upasani
- University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
| | - Carrie E Bartley
- Rady Children's Hospital, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
| | - Peter O Newton
- University of California San Diego, San Diego, CA, USA
- Rady Children's Hospital, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA
| | - Burt Yaszay
- University of California San Diego, San Diego, CA, USA.
- Rady Children's Hospital, 3020 Children's Way, MC 5062, San Diego, CA, 92123, USA.
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15
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Kadom N, Palasis S, Pruthi S, Biffl WL, Booth TN, Desai NK, Falcone RA, Jones JY, Joseph MM, Kulkarni AV, Marin JR, Milla SS, Mirsky DM, Myseros JS, Reitman C, Robertson RL, Ryan ME, Saigal G, Schulz J, Soares BP, Tekes A, Trout AT, Whitehead MT, Karmazyn B. ACR Appropriateness Criteria® Suspected Spine Trauma-Child. J Am Coll Radiol 2019; 16:S286-S299. [DOI: 10.1016/j.jacr.2019.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 12/29/2022]
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16
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Abstract
Acute onset of neurological signs and symptoms referable to the spine including difficulty walking, bowel and bladder dysfunction, and paresthesias in the extremities may be manifestations of pediatric spine emergency. Trauma is the most common etiology for a pediatric spinal emergency. Because a history of trauma is often available, the role of imaging involves detection of spinal injuries. Other pathologies such as infection, inflammation, vascular, and neoplasms may lead to pediatric spinal emergencies that also require imaging for assistance in determining the etiology and appropriate management.
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Affiliation(s)
- Katie Suzanne Traylor
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Stephen F Kralik
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202
| | - Rupa Radhakrishnan
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN 46202.
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17
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Fernandes LG, Cristante AF, Marcon RM, de Barros Filho TEP, Letaif OB. Feasibility of anterior screw fixation in children: a tomographic study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:1388-1392. [PMID: 29427010 DOI: 10.1007/s00586-018-5504-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 01/28/2018] [Indexed: 12/30/2022]
Abstract
PURPOSE Morphology measures of the odontoid process in children under 12 years old were carried out to demonstrate the viability of anterior internal fixation in this population once their active profile may not be compatible with successful conservative treatment. METHODS During a 6-month period, 36 tomographic examinations of the cervical spine region that provided visualization of the odontoid process were selected. Group 1 included children between 6 and 9 years of age, and group 2 contained children from 9 to 12 years of age. There were 23 (63.8%) male patients and 13 (36.2%) female patients. Patients diagnosed with a tumor, an infection, fracture non-union, or congenital malformation were excluded. Exams were ordered as part of a protocol applied to non-specific neck pain and pediatric trauma entries. The following parameters were analyzed: (1) screw attack angle, (2) height of the odontoid process, and (3) minimal transverse diameter of the odontoid process. RESULTS In Groups 1 and 2, the average values of the screw attack angle were 55.9° ± 2.3° and 54.8° ± 4.5°, respectively; the average heights of the odontoid process were 26.58 ± 3.28 and 29.48 ± 3 mm, respectively, and the average minimal transverse diameter of the odontoid process were 6.57 ± 1.08 and 6.23 ± 0.88 mm, respectively. The minimal transverse diameter of the odontoid process was statistically higher in males than that in females, regardless of age (p = 0.007). CONCLUSION In both groups, the minimal transverse diameter of the odontoid process allowed for the use of one 3.5-4.5 mm screw for anterior internal fixation. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Lívia Gaspar Fernandes
- Spine Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
| | - Alexandre Fogaça Cristante
- Spine Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Raphael Martus Marcon
- Spine Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Olavo Biraghi Letaif
- Spine Surgery Division, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil
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18
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Rossi A, Martinetti C, Morana G, Severino M, Tortora D. Diagnostic Approach to Pediatric Spine Disorders. Magn Reson Imaging Clin N Am 2017; 24:621-44. [PMID: 27417404 DOI: 10.1016/j.mric.2016.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Understanding the developmental features of the pediatric spine and spinal cord, including embryologic steps and subsequent growth of the osteocartilaginous spine and contents is necessary for interpretation of the pathologic events that may affect the pediatric spine. MR imaging plays a crucial role in the diagnostic evaluation of patients suspected of harboring spinal abnormalities, whereas computed tomography and ultrasonography play a more limited, complementary role. This article discusses the embryologic and developmental anatomy features of the spine and spinal cord, together with some technical points and pitfalls, and the most common indications for pediatric spinal MR imaging.
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Affiliation(s)
- Andrea Rossi
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy.
| | - Carola Martinetti
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Giovanni Morana
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Mariasavina Severino
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
| | - Domenico Tortora
- Neuroradiology Unit, Istituto Giannina Gaslini, Via Gerolamo Gaslini, 5, Genova 16147, Italy
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Buckland AJ, Bressan S, Jowett H, Johnson MB, Teague WJ. Heterogeneity in cervical spine assessment in paediatric trauma: A survey of physicians' knowledge and application at a paediatric major trauma centre. Emerg Med Australas 2016; 28:569-74. [PMID: 27474412 DOI: 10.1111/1742-6723.12650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/17/2016] [Accepted: 06/26/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. METHODS A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken. Participation was voluntary and responses de-idenitified. The survey comprised 20 questions regarding initial assessment, imaging, immobilisation and perioperative management. Physicians' responses were compared with available current evidence. RESULTS Sixty-seven physicians (28% registrars, 17% fellows and 55.2% consultants) participated. Physicians rated altered mental state, intoxication and distracting injury as the most important contraindications to cervical spine clearance in children. Fifty-four per cent considered adequate plain imaging to be 3-view cervical spine radiographs (anterior-posterior, lateral and odontoid), whereas 30% considered CT the most sensitive modality for detecting unstable cervical spine injuries. Physicians' responses reflected marked heterogeneity regarding semi-rigid cervical collars and what constitutes cervical spine 'clearance'. Greater consensus existed for perioperative precautions in this setting. CONCLUSIONS Physicians actively engaged in paediatric trauma care demonstrate marked heterogeneity in their knowledge and application of cervical spine assessment. This is compounded by a lack of paediatric-specific evidence and definitions, involvement of multiple specialties and staff turnover within busy departments. A validated decision-making tool for cervical spine assessment will represent an important advance in paediatric trauma.
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Affiliation(s)
- Aaron J Buckland
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia.,NYU Langone Medical Center - Hospital for Joint Diseases, New York, New York, USA
| | - Silvia Bressan
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia.,Emergency Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.,Department of Woman's and Child's Health, University of Padova, Padova, Italy
| | - Helen Jowett
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michael B Johnson
- Department of Orthopaedics, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Warwick J Teague
- Trauma Service, The Royal Children's Hospital, Melbourne, Victoria, Australia. .,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia. .,Surgical Research Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
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Trauma. HANDBOOK OF CLINICAL NEUROLOGY 2016. [PMID: 27430465 DOI: 10.1016/b978-0-444-53486-6.00062-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Traumatic brain and spine injury (TBI/TSI) is a leading cause of death and lifelong disability in children. The biomechanical properties of the child's brain, skull, and spine, the size of the child, the age-specific activity pattern, and variance in trauma mechanisms result in a wide range of age-specific traumas and patterns of brain and spine injuries. A detailed knowledge about the various types of primary and secondary pediatric head and spine injuries is essential to better identify and understand pediatric TBI/TSI, which enhances sensitivity and specificity of diagnosis, will guide therapy, and may give important information about the prognosis. The purposes of this chapter are to: (1) discuss the unique epidemiology, mechanisms, and characteristics of TBI/TSI in children; (2) review the anatomic and functional imaging techniques that can be used to study common and rare pediatric TBI/TSI and their complications; (3) comprehensively review frequent primary and secondary brain injuries; and (4) to give a short overview of two special types of pediatric TBI/TSI: birth-related and nonaccidental injuries.
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21
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Chronic Ventilatory Support for Children Following Trauma or Severe Neurologic Injury. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Abstract
BACKGROUND Limited data exist on pediatric subaxial cervical spine injuries. The goal of this study was to characterize the injuries and initial treatment of a large consecutive series of patients with injuries from C3 to C7. METHODS Medical records and radiographs of consecutive patients admitted with cervical spine fractures and/or dislocations at a single level 1 pediatric trauma center from 2003 to 2013 were reviewed. Data abstracted included age, injury type and level, mechanism of injury, associated nonspine injuries, neurological status, length of hospitalization, and initial treatment. RESULTS Fifty-one patients were grouped into 3 age ranges: infant, 0 to 3 years (2); youth, 4 to 12 years (13); and adolescent, 13 to 16 years (36). Isolated fractures were identified in both infants and accounted for most of injuries in youths (85%) and adolescents (86%). Single vertebra or single vertebral level injuries were present in 65% of patients, most commonly at C7 (36%) or C6 (29%). No correlation existed between cervical level injured and patient age. Multiple cervical spine injuries occurred in 1 infant, 3 youths, and 14 adolescents. Other concomitant thoracic and/or lumbar spine injuries were found in 1 infant and 3 adolescents. The most common mechanisms of injury were motor vehicle accidents (53%) and sports (14%). High-energy trauma was associated with higher rates of noncontiguous spinal injuries and associated nonspinal injuries, with a longer length of hospitalization. Neurological deficits were observed in 8 patients: 1 infant, 2 youths, and 5 adolescents, of which 5 resulted from high-energy trauma. One infant and all youth patients were treated nonoperatively; 26 adolescents (73%) were treated in a cervical collar or with observation, 1 was treated with halo-vest immobilization, and 9 had surgical treatment. CONCLUSIONS Most subaxial cervical spine injuries in pediatric and adolescent patients are isolated fractures at C6 and C7. High-energy mechanisms are associated with noncontiguous spinal injuries and other nonspine injuries. Most patients can be treated in a cervical collar, but adolescent patients are more likely to require halo placement or surgical intervention. LEVEL OF EVIDENCE Level IV-retrospective, diagnostic.
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Huisman TAGM, Wagner MW, Bosemani T, Tekes A, Poretti A. Pediatric spinal trauma. J Neuroimaging 2014; 25:337-53. [PMID: 25512255 DOI: 10.1111/jon.12201] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/23/2014] [Accepted: 08/16/2014] [Indexed: 12/19/2022] Open
Abstract
Pediatric spinal trauma is unique. The developing pediatric spinal column and spinal cord deal with direct impact and indirect acceleration/deceleration or shear forces very different compared to adult patients. In addition children are exposed to different kind of traumas. Moreover, each age group has its unique patterns of injury. Familiarity with the normal developing spinal anatomy and kind of traumas is essential to correctly diagnose injury. Various imaging modalities can be used. Ultrasound is limited to the neonatal time period; plain radiography and computer tomography are typically used in the acute work-up and give highly detailed information about the osseous lesions. Magnetic resonance imaging is more sensitive for disco-ligamentous and spinal cord injuries. Depending on the clinical presentation and timing of trauma the various imaging modalities will be employed. In the current review article, a summary of the epidemiology and distribution of posttraumatic lesions is discussed in the context of the normal anatomical variations due to progressing development of the child.
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Affiliation(s)
- Thierry A G M Huisman
- Russell H. Morgan Department of Radiology and Radiological Science, Division of Pediatric Radiology, Section of Pediatric Neuroradiology, The Johns Hopkins University School of Medicine, Baltimore, MD
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Ovalle FAT, Ríos EC, Balbuena FR. Incidence and functional evolution of traumatic injuries of the spine. COLUNA/COLUMNA 2014. [DOI: 10.1590/s1808-1851201413030r106] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To determine the incidence and functional outcome of traumatic injuries of the spine in the period from January 1, 2013 to December 31, 2013, at the General Hospital "Dr. Rafael Pascacio Gamboa", state of Chiapas, México. METHODS: A retrospective, cross-sectional, descriptive, observational study, where all patients seeking medical and surgical care in the emergency department and inpatient unit for a traumatic spinal injury were included, regardless of age or sex. RESULTS: A sample of 60 patients, of whom 43 were male (71.7%) and 17 females (28.3%), with an average age of 35 was obtained. As for the cause of the injury, falls were the leading cause (61.7%) followed by motor vehicle accidents (35%) and finally, assaults (3.3%). In this sample, 21% had associated injuries being the most common (7.3%) the thoracic trauma. The most common site of injury was the thoracic spine, followed by the lower cervical and finally the thoracolumbar ones. We found that 70% of patients had partial or complete neurological injury, with complete spinal cord transection (Frankel A) being the most frequent lesion in 53%. CONCLUSION: The incidence in our series is similar that the reported in developing countries which have sociocultural problems similar to ours. The same applies to the etiology of these lesions, which is closely linked to social and economic activity in each country or region.
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Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma 2014; 31:531-40. [PMID: 23962031 PMCID: PMC3949434 DOI: 10.1089/neu.2013.3094] [Citation(s) in RCA: 95] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The cervical collar has been routinely used for trauma patients for more than 30 years and is a hallmark of state-of-the-art prehospital trauma care. However, the existing evidence for this practice is limited: Randomized, controlled trials are largely missing, and there are uncertain effects on mortality, neurological injury, and spinal stability. Even more concerning, there is a growing body of evidence and opinion against the use of collars. It has been argued that collars cause more harm than good, and that we should simply stop using them. In this critical review, we discuss the pros and cons of collar use in trauma patients and reflect on how we can move our clinical practice forward. Conclusively, we propose a safe, effective strategy for prehospital spinal immobilization that does not include routine use of collars.
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Affiliation(s)
- Terje Sundstrøm
- 1 Department of Biomedicine, University of Bergen , Bergen, Norway
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Abstract
BACKGROUND Over half of children and adolescents with spinal trauma have associated injuries, most commonly involving the appendicular skeleton, head and neck, and thorax. The incidence and characteristics of these associated injuries have been well described, but to our knowledge there has been no evaluation of the relationship between the injury characteristics and the patient age. METHODS Data were obtained from the trauma registries of the local pediatric and adult level 1 trauma centers, and patients aged 0 to 19 years with spinal trauma were identified. For analysis, patients were divided into 3 age groups: 0 to 3, 4 to 12, and 13 to 19 years. Associated injuries were divided into 5 groups: head, thoracic, abdominal, appendicular skeletal fracture, and neurological. RESULTS Overall, 25 patients had isolated dislocations and 307 patients had 366 spinal fractures or fracture-dislocations: 36% cervical, 31% thoracic, and 51% lumbar. Most (84%) of the injuries occurred in the 13- to 19-year-old group. Sixty-two percent of patients had associated injuries, most commonly thoracic injuries (pulmonary contusion, pneumothorax, rib fracture); 45% had multilevel spinal fractures, 39% of which were noncontiguous. Nearly three fourths of the noncontiguous fractures occurred in a different spinal region; cervical fracture with concomitant thoracic fracture was the most frequent pattern. CONCLUSIONS This large series of consecutive patients highlights several important concepts concerning pediatric spinal fractures, including age-related patterns of injury, frequent associated injuries, and a high rate of multiple spinal injuries, especially noncontiguous injuries. It also emphasizes the importance of careful full-body examination and imaging of the entire spine in children and adolescents with a known spinal injury. LEVEL OF EVIDENCE Level IV-case series.
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Bibliography Current World Literature. CURRENT ORTHOPAEDIC PRACTICE 2012. [DOI: 10.1097/bco.0b013e318256e7f2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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