Estimation of normal computed tomography measurements for the upper cervical spine in the pediatric age group

Object Upper cervical spine injuries in the pediatric age group have been recognized as extremely unstable from ligamentous disruption and as potentially lethal. Few measurement norms have been published for the pediatric upper cervical spine to help diagnose this pathological state. Instead, adult measurement techniques and results are usually applied inappropriately to children. The authors propose using high-resolution reconstructed CT scans to define a range of normal for a collection of selected upper cervical spine measurements in the pediatric age group. Methods Sagittal and coronal reformatted images were obtained from thin axial CT scans obtained in 42 children (< 18 years) in a 2-month period. There were 25 boys and 17 girls. The mean age was 100.9 months (range 1–214 months). Six CT scans were obtained for nontrauma indications, and 36 were obtained as part of a trauma protocol and later cleared for cervical spine injury. Six straightforward and direct linear distances—basion-dental interval (BDI); atlantodental interval (ADI); posterior atlantodental interval (PADI); right and left lateral mass interval (LMI); right and left craniocervical interval (CCI); and prevertebral soft-tissue thickness at C-2—that minimized logistical and technical distortions were measured and recorded. Statistical analysis including interobserver agreement, age stratification, and sex differences was performed for each of the 6 measurements. Results The mean ADI was 2.25 ± 0.24 mm (± SD), the mean PADI was 18.3 ± 0.07 mm, the mean BDI was 7.28 ± 0.10 mm, and the mean prevertebral soft tissue width at C-2 was 4.45 ± 0.43 mm. The overall mean CCI was 2.38 ± 0.44 mm, and the overall mean LMI was 2.91 ± 0.49 mm. Linear regression analysis demonstrated statistically significant age effects for PADI (increased 0.02 mm/month), BDI (decreased 0.02 mm/month), and CCI (decreased 0.01 mm/month). Similarly significant effects were found for sex; females demonstrated on average a smaller CCI by 0.26 mm and a smaller PADI by 2.12 mm. Moderate to high interrater reliability was demonstrated across all parameters. Conclusions Age-dependent and age-independent normal CT measurements of the upper cervical spine will help to differentiate physiological and pathological states in children. The BDI appears to change significantly with age but not sex; on the other hand, the LMI and ADI appear to be age-independent measures. This preliminary study suggests acceptable levels of interrater reliability, and further expanded study will aim to validate these measurements to produce a profile of normal upper cervical spine measurements in children.

Download Full-text

Odontoid process fracture in 2 year old child: a rare case report

Romanian Neurosurgery ◽

10.1515/romneu-2017-0080 ◽

2017 ◽

Vol 31 (4) ◽

pp. 522-525

Author(s):

Prajapati Hanuman Prasad ◽

Singh Deepak Kumar ◽

Singh Rakesh Kumar ◽

Yadav Kuldeep

Keyword(s):

Cervical Spine ◽

Odontoid Process ◽

The Body ◽

Upper Cervical Spine ◽

Age Group ◽

Spine Injuries ◽

Rare Case Report ◽

Upper Cervical ◽

Cervical Spine Fractures ◽

Odontoid Process Fracture

Abstract In small childrens spine injuries are rare. In this age group upper cervical spine is commonally affected. Odontoid process fracture involve only a subset of cervical spine fractures. In small childrens, this fracture typically involves the cartilaginousplate that separates the odontoid process from the body of the axis. Odontoid processfracture is rare in children less than 7 years of age.

Download Full-text

Fixation with C-2 laminar screws in occipitocervical or C1–2 constructs in children 5 years of age or younger: a series of 18 patients

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.3.peds13626 ◽

2014 ◽

Vol 14 (1) ◽

pp. 87-93 ◽

Cited By ~ 18

Author(s):

Jennifer G. Savage ◽

Daniel H. Fulkerson ◽

Anish N. Sen ◽

Jonathan G. Thomas ◽

Andrew Jea

Keyword(s):

Cervical Spine ◽

Screw Placement ◽

Upper Cervical Spine ◽

Children's Hospital ◽

Translaminar Screw ◽

Upper Cervical ◽

Children’S Hospital ◽

The Mean ◽

Translaminar Screws

Object There are rare indications for upper cervical spine fusion in young children. Compared with nonrigid constructs, rigid instrumentation with screw fixation increases the fusion rate and reduces the need for halo fixation. Instrumentation may be technically challenging in younger children. A number of screw placement techniques have been described. Use of C-2 translaminar screws has been shown to be anatomically feasible, even in the youngest of children. However, there are few data detailing the clinical outcome. In this study, the authors describe the clinical and radiographic follow-up of 18 children 5 years of age or younger who had at least one C-2 translaminar screw as part of an occipitocervical or C1–2 fusion construct. Methods A retrospective review of all children treated with instrumented occipitocervical or C1–2 fusion between July 1, 2007, and June 30, 2013, at Riley Children's Hospital and Texas Children's Hospital was performed. All children 5 years of age or younger with incorporation of at least one C-2 translaminar screw were identified. Results Eighteen children were studied (7 boys and 11 girls). The mean age at surgery was 38.1 months (range 10–68 months). Indications for surgery included traumatic instability (6), os odontoideum (3), destructive processes (2), and congenital instability (7). A total of 24 C-2 translaminar screws were placed; 23 (95.8%) of 24 were satisfactorily placed (completely contained within the cortical walls). There was one medial cortex breach without neurological impingement. There were no complications with screw placement. Three patients required wound revisions. Two patients died as a result of their original condition (trauma, malignant tumor). The mean follow-up duration for the surviving patients was 17.5 months (range 3–60 months). Eleven (91.7%) of the 12 patients followed for 6 months or longer showed radiographic stability or completed fusion. Conclusions Use of C-2 translaminar screws provides an effective anchor for internal fixation of the upper cervical spine. In this study of children 5 years of age or younger, the authors found a high rate of radiographic fusion with a low rate of complications.

Download Full-text

Incidence and Variants of Posterior Arch Defects of the Atlas Vertebra

Radiology Research and Practice ◽

10.1155/2013/957280 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Sebastian Guenkel ◽

Sladjana Schlaepfer ◽

Sonja Gordic ◽

Guido A. Wanner ◽

Hans-Peter Simmen ◽

...

Keyword(s):

Cervical Spine ◽

Congenital Anomalies ◽

Caucasian Population ◽

Ct Scans ◽

Posterior Arch ◽

Upper Cervical Spine ◽

Anterior Arch ◽

Predominant Type ◽

Upper Cervical ◽

Posterior Arch Defects

In order to describe the incidence and existing variants of congenital anomalies of the atlas vertebrae in a Caucasian population, we examined 1069 CT scans of the upper cervical spine. We found 41 cases with altered atlas vertebrae, representing 3.8% of all analyzed patients. With 83% of all found anomalies, the predominant type is characterized by a small dorsal cleft (3.2% of all patients). Rare varieties feature unilateral or bilateral dorsal arch defects, combined anterior and posterior clefts (0.2% of all patients) or total erratic atlas vertebra malformation (0.1% of all patients). Atlas arch defects are found nearly 4% at the time. Most anomalies affect the posterior arch, whereas the anterior arch or both are rarely affected. Totally irregular C1 vertebrae are extremely infrequent.

Download Full-text

Atlantoaxial Subluxation in Different Intraoperative Head Positions in Patients with Rheumatoid Arthritis

Anesthesiology ◽

10.1097/00000542-200604000-00010 ◽

2006 ◽

Vol 104 (4) ◽

pp. 675-679 ◽

Cited By ~ 28

Author(s):

Daisaku Tokunaga ◽

Hitoshi Hase ◽

Yasuo Mikami ◽

Tatsuya Hojo ◽

Kazuya Ikoma ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Cervical Spine ◽

General Anesthesia ◽

Perioperative Period ◽

Head Position ◽

Lateral View ◽

Atlantoaxial Subluxation ◽

Upper Cervical Spine ◽

Upper Cervical ◽

Atlantodental Interval

Background Disorders of the cervical spine are often observed in patients with rheumatoid arthritis (RA). However, the best head position for RA patients with atlantoaxial subluxation in the perioperative period is unknown. This study investigated head position during general anesthesia for the patients with RA and proven atlantoaxial subluxation. Methods During anesthesia of patients with RA and proven atlantoaxial subluxation, the authors used fluoroscopy to obtain a lateral view of the upper cervical spine in four different positions: the mask position, the intubation position, the flat pillow position, and the protrusion position. Copies of the still fluoroscopic images were used to determine the anterior atlantodental interval, the posterior atlantodental interval, and the angle of atlas and axis (C1-C2 angle). Results The anterior atlantodental interval was significantly smaller in the protrusion position (2.3 mm) than in the flat pillow position (5.1 mm) (P < 0.05). The posterior atlantodental interval was significantly greater in the protrusion position (18.9 mm) than in the flat pillow position (16.2 mm) (P < 0.05). The C1-C2 angle was, on average, 9.3 degrees greater in the protrusion position than in the flat pillow position (P < 0.05). Conclusion This study showed that the protrusion position using a flat pillow and a donut-shaped pillow during general anesthesia reduced the anterior atlantodental interval and increased the posterior atlantodental interval in RA patients with atlantoaxial subluxation. This suggests that the protrusion position, which involves support of the upper cervical spine and extension at the craniocervical junction, might be advantageous for these patients.

Download Full-text

Anatomical parameters of subaxial percutaneous transfacet screw fixation based on the analysis of 50 computed tomography scans

Journal of Neurosurgery Spine ◽

10.3171/2012.3.spine11449 ◽

2012 ◽

Vol 16 (6) ◽

pp. 573-578 ◽

Cited By ~ 5

Author(s):

Charles Milchteim ◽

Warren D. Yu ◽

Anthony Ho ◽

Joseph R. O'Brien

Keyword(s):

Analysis Of Variance ◽

Intraclass Correlation ◽

Ct Scans ◽

Screw Placement ◽

Upper Cervical Spine ◽

Entry Angle ◽

Significant Difference ◽

Upper Cervical ◽

The Mean ◽

Transfacet Screw Fixation

Object Cervical transfacet screw placement has been described in the literature. Although the technique shows promise for percutaneous application, parameters for screw placement have not been well delineated. This study used reconstructed CT scans with imaging software to assess the feasibility of percutaneous transfacet screw placement, analyzing potential entry angles, transfacet lengths, and sex differences at each subaxial level. Methods Fifty consecutive cervical CT scans (obtained in 26 males and 24 females [mean age 41.5 years]) were reformatted using OsiriX software, and transfacet lengths, entry angles, and potential occipital clearance were analyzed at all subaxial levels. Statistical analyses were used to determine the differences, if any, between transfacet lengths, entry angle, and occipital clearance across individual cervical levels. Repeatability was quantified by calculating the intraclass correlation coefficient and Cohen kappa value. Results A total of 200 transfacet lengths and 200 entry angles in 50 patients were analyzed. The mean transfacet lengths were 17.9 ± 2.6, 17.6 ± 3.2, 16.3 ± 3.6, and 13.1 ± 2.2 mm at C3–4, C4–5, C5–6, and C6–7, respectively, with mean entry angles at 52.7° ± 7.8°, 56.5° ± 8.0°, 55.0° ± 8.8°, and 53.0° ± 8.7°, respectively. Analysis of variance revealed a significant difference between the mean transfacet lengths, while post hoc analysis revealed significantly larger transfacet lengths in the upper 2 cervical levels (C3–4 and C4–5) than in the lower 2 cervical levels (C5–6 and C6–7). Analysis of variance demonstrated no significant difference between the entry angles. Males had significantly larger transfacet lengths at C5–6 (17.4 vs 15.1 mm) and C6–7 (13.7 vs 12.4 mm) than females. The occiput would have blocked percutaneous screw placement in 86%, 78%, 54%, and 20% of the cases at C3–4, C4–5, C5–6, and C6–7, respectively. Transfacet lengths may accommodate longer screws in the upper cervical spine, but potential screw sizes decrease in the lower subaxial levels. A transfacet entry angle of approximately 50° or greater was associated with a higher incidence of occipital clearance. Additionally, the occiput may pose a significant obstruction to percutaneous transfacet fixation in upper subaxial levels. Interrater reliability was poor for screw angle and length measurements, but was satisfactory in intrarater analysis in 6 of 8 measurements. There was moderate to good agreement of occipital clearance in all but one measurement. Conclusions Cervical transfacet screw placement is possible from C-3 to C-7. Because occipital clearance can be difficult at C3–4 and C6–7, the use of curved or flexible instruments may be necessary to obtain the appropriate screw trajectory. Screw lengths varied with spinal level and the sex of the patient.

Download Full-text

ROLE OF RADIOSURGERY IN THE MANAGEMENT OF CEREBRAL ARTERIOVENOUS MALFORMATIONS IN THE PEDIATRIC AGE GROUP

Neurosurgery ◽

10.1227/01.neu.0000249277.72063.bd ◽

2007 ◽

Vol 60 (2) ◽

pp. 268-276 ◽

Cited By ~ 60

Author(s):

Nicolas Reyns ◽

Serge Blond ◽

Jean-Yves Gauvrit ◽

Gustavo Touzet ◽

Bernard Coche ◽

...

Keyword(s):

Predictive Factors ◽

Arteriovenous Malformations ◽

Age Group ◽

Pediatric Age ◽

Pediatric Age Group ◽

Complete Obliteration ◽

Prescription Dose ◽

The Mean ◽

Permanent Neurological Deficit

Abstract OBJECTIVE To assess the safety and efficacy of radiosurgery for the management of arteriovenous malformations (AVMs) in the pediatric age group. METHODS We reviewed data from 100 children (44 girls and 56 boys) presenting a total of 103 AVMs treated by linear accelerator radiosurgery between December 1988 and May 2002. The median patient age was 12 years (range, 2–16 yr). Sixty-seven AVMs (65%) were in functional locations and 30% were inoperable. The mean AVM volume was 2.8 cm3 (range, 0.9–21.3 cm3). The mean marginal dose was 23 Gy (range, 15–25 Gy) and required between one and four isocenters. Fifty patients received multimodal treatments with embolization and/or surgery before and/or after radiosurgery. Given that 16 patients underwent two sessions of radiosurgery and one patient received three sessions, a total of 119 radiosurgical treatments were delivered. We maintained our clinical and angiographic follow-up for at least 36 months after irradiation or until the complete obliteration of the AVM was confirmed by angiography (our sole end point for judging clinical efficacy). Univariate and multivariate analysis were performed to determine predictive factors for obliteration. RESULTS Complete obliteration was achieved for 72 AVMs (70%). The permanent neurological deficit rate was 5%. One patient died because of rebleeding. None of our patients presented bleeding after an angiographically verified AVM obliteration. The main predictive factors for obliteration were low AVM volume and no previous embolization. Moreover, the younger the patient, the more effective the radiosurgery seemed to be. CONCLUSION Radiosurgery is a safe and effective treatment for AVMs in the pediatric age group. One criterion for success was the use of a prescription dose similar to that used with adult populations.

Download Full-text

Effect of Active Cranio Cervical Flexion Exercise of Upper Cervical Spine on Pain, Cervical Range of Motion and Craniocervical Flexion Test (CCFT) in Patients with Age Group 20–40 Years of Chronic Neck Pain

Indian Journal of Physiotherapy and Occupational Therapy - An International Journal ◽

10.5958/0973-5674.2019.00047.9 ◽

2019 ◽

Vol 13 (2) ◽

pp. 64

Author(s):

Ganesh MSP ◽

Komal Mali

Keyword(s):

Cervical Spine ◽

Neck Pain ◽

Range Of Motion ◽

Chronic Neck Pain ◽

Upper Cervical Spine ◽

Age Group ◽

Cervical Range Of Motion ◽

Upper Cervical ◽

Flexion Test

Download Full-text

Primary meningeal sarcoma (fibrosarcoma) of cervical spine in an 11 yr old boy: An extremely rare case report

Romanian Neurosurgery ◽

10.1515/romneu-2017-0032 ◽

2017 ◽

Vol 31 (2) ◽

pp. 203-206

Author(s):

Kumar Pradeep ◽

Verma Pawan Kumar ◽

Das Srikant ◽

Gupta Ashok

Keyword(s):

Case Report ◽

Cervical Spine ◽

Rare Case ◽

Malignant Potential ◽

Age Group ◽

Pediatric Age ◽

Rare Tumor ◽

Pediatric Age Group ◽

Rare Case Report ◽

Meningeal Sarcoma

Abstract Primary meningeal sarcoma is a rare tumor in pediatric age group. Here we were reporting an extremly rare case report of an 11 year old boy presented with quadriparesis and bladder involvement. MRI revealed a cervical dural based tumor with extension to cord parenchyma and neural foramina involving paravertebral tissue. The histopathology revealed mesenchymal tumor with malignant potential which on immunohistochemical (IHC) study found to be vimentin positive fibrosarcoma.

Download Full-text

Comparison of Pediatric and Adult Tonsillectomies Performed by Thermal Welding System

International Journal of Otolaryngology ◽

10.1155/2013/265105 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 6

Author(s):

Tolga Ersözlü ◽

Yavuz Selim Yıldırım ◽

Selman Sarica

Keyword(s):

Postoperative Bleeding ◽

Age Groups ◽

Adult Patients ◽

Age Group ◽

Pediatric Age ◽

Adult Age ◽

Pediatric Age Group ◽

The Mean ◽

Thermal Welding ◽

Welding System

Objective.To compare pediatric and adult age groups in terms of postoperative bleeding and pain following tonsillectomy performed by thermal welding system (TWS).Method.The study consisted of 213 patients, of whom 178 were children and 35 were adults. The mean age of the pediatric patients (81 girls and 97 females) was6.7±2.4years (range 3–13 years) and the mean age of the adults (20 males and 15 females) was21.8±7.07years (range 15–41 years). All of the patients were evaluated in terms of postoperative bleeding and pain following tonsillectomy performed by TWS.Results.Bleeding was detected in the late postoperative period in 11 pediatric and 7 adult patients and of them 2 pediatric and 3 adult patients controlled under general. Postoperative bleeding was significantly less prevalent in the pediatric age group compared to the adult age group (P=0.04). Likewise, postoperative pain was significantly less prevalent in the pediatric age group as compared to the adult age group (P<0.001).Conclusion.Both postoperative bleeding and pain following tonsillectomy performed by TWS were more prevalent in the adult age group compared to the pediatric age group.

Download Full-text