Anterior Spinal Artery Infarct Secondary to “Rotatory Atlantoaxial Subluxation” in a Pediatric Patient: A Case Report and Review of the Literature

Abstract

Spinal cord infarction in children is a rare condition that is becoming more widely recognized. There are few reports in the pediatric literature characterizing etiology, diagnosis, treatment options, and prognosis of anterior spinal artery infarction following rotatory atlantoaxial subluxation. In many children, the cause of spinal cord ischemia in the absence of vertebral fracture is unknown and is often wrongly diagnosed. Imaging diagnosis of spinal cord ischemia is often difficult due to the small transverse area of the cord, cerebrospinal fluid artifact, and inadequate resolution. The prognosis depends on the level of spinal cord damage, early identification and reversal of ischemia, and follow-up with intensive physical therapy and medical support. In addition to summarizing the literature on spinal cord infarction in children following cervical trauma, this article adds to the literature another case of a child with anterior spinal artery territory infarction due to rotatory atlantoaxial subluxation, leading to kinking and occlusion of vertebral artery, which highlights the difficulties and controversies in the management of this condition.