Treatment of upper cervical subluxation in pediatric patients

2009 ◽  
Vol 14 (4) ◽  
pp. 448-451 ◽  
Author(s):  
Sen-Wei Tsai ◽  
Jin-Deng Zhong ◽  
Yan-Wen Chen ◽  
Shyi-Kuen Wu ◽  
Yi-Wen Lin
Keyword(s):  
Pediatric Patients ◽  
Upper Cervical ◽  
Cervical Subluxation

Craniocervical decompression for cervicomedullary compression in pediatric patients with achondroplasia

1990 ◽  
Vol 73 (3) ◽  
pp. 375-382 ◽  
Author(s):  
John Aryanpur ◽  
Orest Hurko ◽  
Clair Francomano ◽  
Henry Wang ◽  
Benjamin Carson
Keyword(s):  
Pediatric Patients ◽  
Foramen Magnum ◽  
Respiratory Compromise ◽  
Content Type ◽  
Standardized Protocol ◽  
Csf Leakage ◽  
Upper Cervical ◽  
Csf Diversion ◽  
Respiratory Complaints ◽  
Cervicomedullary Compression

✓ The congenital osseous abnormalities associated with achondroplasia include stenosis of the foramen magnum and the upper cervical spinal canal. In the pediatric achondroplastic patient, such stenosis may lead to cervicomedullary compression with serious sequelae, including paresis, hypertonia, delayed motor milestones, and respiratory compromise. Using a standardized protocol the authors have treated 15 young achondroplastic patients with documented cervicomedullary compression by craniocervical decompression and duroplasty. Following this procedure, significant improvement in presenting neurological or respiratory complaints was noted in all patients. The mortality rate in this series was zero. The major cause of morbidity associated with this procedure was perioperative cerebrospinal fluid (CSF) leakage from the surgical wound, presumably related to coexisting abnormalities of CSF dynamics. This problem was successfully managed by temporary or, when necessary, permanent CSF diversion procedures. It is concluded that craniocervical decompression is an effective and safe treatment for young achondroplastic patients with cervicomedullary compression.

MOBILITY OF THE UPPER CERVICAL SPINE IN HEALTH AND DISEASE

PEDIATRICS ◽  
1952 ◽  
Vol 10 (5) ◽  
pp. 567-574
Author(s):  
EDWARD H. TOWNSEND ◽  
M. LAURENS ROWE
Keyword(s):  
Cervical Spine ◽  
Muscle Spasm ◽  
Cervical Region ◽  
Upper Cervical Spine ◽  
Upper Respiratory Infection ◽  
Erroneous Diagnosis ◽  
Upper Cervical ◽  
Health And Disease ◽  
Cervical Subluxation ◽  
Upper Respiratory

Four cases of cervical "subluxation" have been presented due to muscle spasm in the cervical region, which occurred during an upper respiratory infection. This syndrome differs from the atlanto-axial subluxation. Roentgenograms in the diagnosis of this condition may lead to erroneous diagnosis and treatment. The normal anatomic and functional ranges of the cervical spine were studied and are discussed. The degree of mobility of the cervical spine is greater than previously assumed.

scholarly journals Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years

2017 ◽  
Vol 1 (1) ◽  
pp. 14-19
Author(s):  
Kei Watanabe ◽  
Toru Hirano ◽  
Keiichi Katsumi ◽  
Masayuki Ohashi ◽  
Hirokazu Shoji ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Cervical Fusion ◽  
Radiographic Outcomes ◽  
Upper Cervical

USE OF AXIAL AND SUBAXIAL TRANSLAMINAR SCREW FIXATION IN THE MANAGEMENT OF UPPER CERVICAL SPINAL INSTABILITY IN A SERIES OF 7 CHILDREN

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 734-739 ◽  
Author(s):  
Roukoz B. Chamoun ◽  
Katherine M. Relyea ◽  
Keyne K. Johnson ◽  
William E. Whitehead ◽  
Daniel J. Curry ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Screw Fixation ◽  
Screw Placement ◽  
Os Odontoideum ◽  
Spinal Instability ◽  
Screw Insertion ◽  
Translaminar Screw Fixation ◽  
Translaminar Screw ◽  
Upper Cervical ◽  
Translaminar Screws

Abstract OBJECTIVE The management of upper cervical spinal instability in children continues to represent a technical challenge. Traditionally, a number of wiring techniques followed by halo orthosis have been applied; however, they have been associated with a high rate of nonunion and poor tolerance for the halo. Alternatively, C1–C2 transarticular screws and C2 pars/pedicle screws allow more rigid fixation, but they are technically demanding and associated with vertebral artery injuries. Recently, C2 translaminar screws have been added to the armamentarium of the pediatric spine surgeon as a technically simple and biomechanically efficient method of fixation. However, subaxial translaminar screws have not been described in the pediatric population. We describe our experience with axial and subaxial translaminar screws in 7 pediatric patients. METHODS Seven pediatric patients with the diagnosis of upper cervical spinal instability required surgical fixation (age, 19 months–14 years; sex, 4 boys and 3 girls; follow-up, 4–21 months; etiology, trauma [3 patients], os odontoideum/os terminale [2 patients], hypoplastic dens [2 patients]). All patients underwent axial and/or subaxial translaminar screw insertion. Iliac crest bone graft was used for fusion in 4 patients; bone morphogenic protein and cancellous morselized allograft was used for fusion in 3 patients. A rigid cervical collar was applied for 12 weeks postoperatively in all cases. No intraoperative image guidance was used for insertion of the translaminar screws. RESULTS All patients had a postoperative computed tomographic scan. Two patients underwent placement of bilateral crossing C2 translaminar screws. Two patients had subaxial translaminar screw placement at C3 and the upper thoracic spine, respectively. Hybrid constructs (a C2 translaminar screw combined with a C2 pars screw) were incorporated in 3 patients. No patients were found to have a breach of the ventral laminar cortex. All patients achieved solid fusion. One patient had a perioperative complication: prolonged dysphagia probably related to C1 lateral mass screw insertion rather than C2 translaminar screw placement. CONCLUSION To our knowledge, this report represents the only series of pediatric patients treated with axial and subaxial translaminar screws. This series shows that axial and subaxial translaminar screw fixation is a viable option for upper cervical spinal fusion in children. The technique is safe and results in adequate fixation with high fusion rates and minimal complications.

scholarly journals Feasibility of CT-based intraoperative 3D stereotactic image-guided navigation in the upper cervical spine of children 10 years of age or younger: initial experience

2015 ◽  
Vol 16 (5) ◽  
pp. 590-598 ◽  
Author(s):  
Timothy J. Kovanda ◽  
Shaheryar F. Ansari ◽  
Rabia Qaiser ◽  
Daniel H. Fulkerson
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Pediatric Patients ◽  
Pedicle Screws ◽  
Upper Cervical Spine ◽  
Initial Experience ◽  
Cervical Spine Surgery ◽  
Image Guided ◽  
Surgical Tool ◽  
Upper Cervical

OBJECT Rigid screw fixation may be technically difficult in the upper cervical spine of young children. Intraoperative stereotactic navigation may potentially assist a surgeon in precise placement of screws in anatomically challenging locations. Navigation may also assist in defining abnormal anatomy. The object of this study was to evaluate the authors’ initial experience with the feasibility and accuracy of this technique, both for resection and for screw placement in the upper cervical spine in younger children. METHODS Eight consecutive pediatric patients 10 years of age or younger underwent upper cervical spine surgery aided by image-guided navigation. The demographic, surgical, and clinical data were recorded. Screw position was evaluated with either an intraoperative or immediately postoperative CT scan. RESULTS One patient underwent navigation purely for guidance of bony resection. A total of 14 navigated screws were placed in the other 7 patients, including 5 C-2 pedicle screws. All 14 screws were properly positioned, defined as the screw completely contained within the cortical bone in the expected trajectory. There were no immediate complications associated with navigation. CONCLUSIONS Image-guided navigation is feasible within the pediatric cervical spine and may be a useful surgical tool for placing screws in a patient with small, often difficult bony anatomy. The authors describe their experience with their first 8 pediatric patients who underwent navigation in cervical spine surgery. The authors highlight differences in technique compared with similar navigation in adults.

scholarly journals Upper Cervical Subluxation and Cervicomedullary Junction Compression in Patients with Rheumatoid Arthritis

2019 ◽  
Vol 62 (6) ◽  
pp. 661-670 ◽  
Author(s):  
Jaewoo Chung ◽  
Koang Hum Bak ◽  
Hyeong-Joong Yi ◽  
Hyoung Joon Chun ◽  
Je Il Ryu ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervicomedullary Junction ◽  
Upper Cervical ◽  
Cervical Subluxation

scholarly journals Complications of Posterior Fusion for Atlantoaxial Instability in Children With Down Syndrome

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 778-785
Author(s):  
Yoshiki Takeoka ◽  
Kenichiro Kakutani ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Takashi Yurube ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Pediatric Patients ◽  
Perioperative Complications ◽  
Donor Site ◽  
Operation Time ◽  
Posterior Fusion ◽  
Atlantoaxial Instability ◽  
Children With Down Syndrome ◽  
Estimated Blood Loss ◽  
Upper Cervical

Objective: To clarify the complications of posterior fusion for atlantoaxial instability (AAI) in children with Down syndrome and to discuss the significance of surgical intervention.Methods: Twenty pediatric patients with Down syndrome underwent posterior fusion for AAI between February 2000 and September 2018 (age, 6.1 ± 1.9 years). C1–2 or C1–3 fusion and occipitocervical fusion were performed in 14 and 6 patients, respectively. The past medical history, operation time, estimated blood loss (EBL), duration of Halo vest immobilization, postoperative follow-up period, and intra- and perioperative complications were examined.Results: The operation time was 257.9 ± 55.6 minutes, and the EBL was 101.6 ± 77.9 mL. Complications related to the operation occurred in 6 patients (30.0%). They included 1 major complication (5.0%): hydrocephalus at 3 months postoperatively, possibly related to an intraoperative dural tear. Other surgery-related complications included 3 cases of superficial infections, 1 case of bone graft donor site deep infection, 1 case of C2 pedicle fracture, 1 case of Halo ring dislocation, 1 case of pseudoarthrosis that required revision surgery, and 1 case of temporary neurological deficit after Halo removal at 2 months postoperatively. Complications unrelated to the operation included 2 cases of respiratory infections and 1 case of implant loosening due to a fall at 9 months postoperatively.Conclusion: The complication rate of upper cervical fusion in patients with Down syndrome remained high; however, major complications decreased substantially. Improved intra- and perioperative management facilitates successful surgical intervention for upper cervical instability in pediatric patients with Down syndrome.

Audiology Service Models in a Family Physician Practice Setting

2010 ◽  
Vol 6 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Sridhar Krishnamurti
Keyword(s):  
Pediatric Patients ◽  
Practice Patterns ◽  
Healthcare Delivery ◽  
Direct Consequence ◽  
Direct Access ◽  
Practice Setting ◽  
Pediatric Populations ◽  
Family Practice Physicians ◽  
Primary Focus ◽  
Balance Problems

This article illustrates the potential of placing audiology services in a family physician’s practice setting to increase referrals of geriatric and pediatric patients to audiologists. The primary focus of family practice physicians is the diagnosis/intervention of critical systemic disorders (e.g., cardiovascular disease, diabetes, cancer). Hence concurrent hearing/balance disorders are likely to be overshadowed in such patients. If audiologists get referrals from these physicians and have direct access to diagnose and manage concurrent hearing/balance problems in these patients, successful audiology practice patterns will emerge, and there will be increased visibility and profitability of audiological services. As a direct consequence, audiological services will move into the mainstream of healthcare delivery, and the profession of audiology will move further towards its goals of early detection and intervention for hearing and balance problems in geriatric and pediatric populations.

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