Cervical Spine In Children Research Articles

Neurologic recovery following laminectomy and tumor resection of a pediatric cervical synovial osteochondromatosis causing paralysis.

To report the surgical outcome of synovial osteochondromatosis, a rare tumor of the cervical spine, in a 6-year-old boy. A 6-year-old boy presented with muscle weakness in the right deltoid (2) and biceps (4) during a manual muscle test. Magnetic resonance imaging showed a 3 × 2 × 1.5cm mass within the spinal canal at the C4-6 level, compressing the cervical spinal cord from the right side. Computed tomography revealed hyperintense areas within the tumor and ballooning of the right C4-5 and C5-6 facet joints. After a biopsy confirmed the absence of malignancy, a gross total resection was performed. The pathological diagnosis of synovial osteochondromatosis was established. Postoperatively, muscle weakness improved fully in the manual muscle test, and there were no neurological findings after 3months. However, the patient is under careful follow-up owing to the detection of a regrowth site within the right C4-5 and C5-6 intervertebral foramen 2years postoperatively. Synovial osteochondromatosis of the cervical spine in children is rare, and this is the first report of its regrowth after surgery. Synovial osteochondromatosis should be included in the differential diagnosis of pediatric cervical spine tumors.

Pediatric cervical spine clearance after blunt trauma and negative CT: What is the role of MRI?

Background and purposeThe cervical spine in children has marked anatomical and biomechanical differences compared to adults, leading to significantly different patterns and incidence of spinal injury, and consequently to different X-ray and computed tomography (CT) imaging recommendations. Magnetic resonance imaging (MRI) has been validated to clear cervical spine trauma in adults, but not in pediatric patients. We hypothesized that MRI findings have a low probability to change management in children with spine trauma and negative CT findings. Materials and methodsWe reviewed records for admitted pediatric patients due to blunt trauma from January 2011 to May 2021, and identified 212 patients who underwent MRI within 3 days of a negative CT. Two neuroradiologists independently reviewed all CT and MRI images for the following categories: fracture, subluxation, spinal canal compromise, ligamentous injury, spinal canal hemorrhage, cord contusion and soft tissue hemorrhage. We identified follow-up MRI examinations as negative or positive for the above categories, and calculated the prevalence of each category as a percentage of cases with negative CT. We also evaluated whether negative and positive MRI groups differed significantly with respect to age and sex of the patients. Results and conclusionsIn our study of 212 children with cervical spine trauma and a negative CT, most follow-up MRI scans were found to be negative (79.9 %). Positive MRI findings consisted mainly of ligamentous sprain without disruption (15.1 %). Ligamentous disruption and epidural or soft tissue hemorrhage were found in 4.5 %, and focal cord contusion in 0.5 %. There was no statically significant difference between negative and positive MRI groups with respect to age (P = 0.45) and sex (P = 0.52). ConclusionIn our patient group with a negative CT, MRI did not significantly impact management nor contribute to cervical spine clearance in children.

Дослідження взаємозв’язків параметрів краніоцервікального, назофарингеального комплексів та зубо-щелепного апарату пацієнтів з дистальною оклюзією (огляд літератури)

Abstract. Every year, the amount of children with diseases of the upper respiratory tract, musculoskeletal system, and maxillofacial system is increasing. The child’s body is extremely sensitive to adverse factors affecting both the growth and development of the body in general and the skull in particular. Some researchers attribute the pathological state of the upper respiratory tract and musculoskeletal system to the factors of inhibiting development of the dentition-maxillary apparatus. The prevalence and severity of dentognathic deformities in children with an existing disbalance of the Musculo-skeletal complex is greater than in somatically healthy children and increases with age, which determines the necessity for timely and multi-stage rehabilitation of these patients. In order to research the pathogenetic corellations between the parameters of the skull and the cervical spine in children with complex pathology, 21 literary sources from the scientometric database of medical research-base «PubMed» for the period 2016-2024 were included in the review and analyzed, which shed light on the issue of complex treatment of patients with dentognathic deformities and existing accompanying pathology. The analysis of articles studying the lateral cephalograms of patients with complex pathology and existing class II dentognathic deformities confirmed the presence of a statistically reliable corellations between the parameters of the cervical spine and the parameters of the jaws, which is most pronounced during the period of peak growth of the facial skeleton. Studies that included three-dimensional morphometric analysis of cone-beam computed tomography of patients with distal occlusion and concomitant pathology confirm the interconnections of average strength between the parameters of the middle and lower parts of the upper respiratory tract and the length of the bodies of the jaws. The creation of a multifactorial model of the disease based on the development and implementation of a multidisciplinary algorithm for complex rehabilitation of patients with distal occlusion and existing pathology of the upper respiratory tract and cervical spine is necessary for the objective assessment of complex pathology, the creation of a joint plan with related specialists and the achievement of a stable treatment result. Key words: distal occlusion, musculoskeletal system, upper respiratory tract, complex treatment.

Iatrogenic atlantoaxial rotatory subluxation after thyroidectomy in a pediatric patient: A case report

Atlantoaxial rotatory subluxation (AARS) is an uncommon disease with a greater prevalence among children than adults, and it is mostly associated with trauma. Iatrogenic spinal injury accounts for a low percentage of injuries. However, in AARS, 20%-40% of cases are associated with surgery, and 48% are caused by infection. Here, we describe our experience with a case of iatrogenic AARS after general anesthesia. A 12-year-old girl presented with right-sided torticollis and cervical motion limit. The patient had undergone thyroidectomy 2 mo ago. Computed tomography revealed AARS with bilateral locked facets. Following the failure of repeated external reduction under general anesthesia, the patient underwent an open surgical reduction. The patient gained atlantoaxial alignment without any complications. Follow-up radiographs showed a normal appearance without instability. The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences. AARS secondary to infection and surgery is known as Grisel's syndrome, which involves non-traumatic AARS. Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported. Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor. Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery. Moreover, clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.

Structure and clinical manifestations of tumor and infectious destructive lesions of the cervical spine in children: 20-year single-center cohort data

Aim. Analysis of the structure and clinical manifesta-tions of tumor and infectious pathology of the cervical spine in children. Design. Retrospective-prospective single- center cohort. Materials and methods. Data from 101 patients with a median age at the time of treat-ment of 7 years (min 11 months, max 17 years) were an-alyzed. Clinical, X-ray, CT, MRI and radioisotope research methods were used. The most common complaint was pain with an intensity of 5 (3.5–7) points on a visual ana-logue scale. Paresis and paralysis were noted in 14.9% of patients. The median duration of the diagnostic pause in the cohort was 3 (2–8) months. The structure of the established pathology: infectious spondylitis — 59.4%, non-bacterial spondylitis — 4.0%, tumors — 36.6%. The pathogen was verified in 31.7% of infectious cases. The tuberculous spondylitis is characterized by a large num-ber of affected vertebrae (Me=4) in comparison with nonspecific spondylitis (Me=1) and tumors (Me=1). The prevalence of the destructive process does not correlate with the duration of the diagnostic pause. A weak rela-tionship was noted between the levels of lesions of the cervical spine and the etiology of the process. Conclu-sion. Analysis of a single-center cohort demonstrates the etiological diversity of destructive lesions of the cer-vical spine in children, the absence of pathognomonic symptoms that can allow early diagnosis as well as the absence of vigilance of primary care physicians in rela-tion to this pathology

Sagittal balance of the cervical spine in children older than 4 years: what is the norm?

Objective. To search for normal parameters of the sagittal balance of the cervical spine in children, to analyze their dynamics in different periods of childhood, and to compare them with the norm given for the adult population.Material and Methods. To assess the parameters of the sagittal balance of the cervical spine, radiographs were selected that were initially evaluated by radiologists as a variant of the norm. The final sample consisted of 73 radiographs of 44 girls and 29 boys aged 4 to 17 years.Digital radiographs were used to evaluate the 10 most common parameters presented in publications: the angular values of Oc–C2, C2–C7, C7S, Th1S, TIA, NT, CeT, CrT, SCA, as well as the cSVA distance measured in mm. The measurements were carried out independently by 3 specialists working with pediatric patients: an orthopedic surgeon (experience up to 5 years), an orthopedic surgeon (experience more than 15 years), and a radiologist specializing in skeletal pathology (experience more than 5 years). The obtained results weresubjected to statistical processing.Results. Using multivariate analysis of variance, the presence of a statistically significant difference in age was revealed only for cSVA, gender differences were revealed for 6 out of 10 parameters. Most of the parameters showed good and satisfactory agreement between specialists.A very strong correlation was established between the parameters C7S and Th1S, which correlates with the adjacent position of the vertebrae.The C2–C7 and SCA parameters have a strong positive correlation with each other, the CeT parameter is strongly negatively correlated with both of them. The TIA has a strong negative correlation with SCA and a moderate positive correlation with NT, CeT, C7S, and Th1S. The cSVA and CrT values strongly correlate only with each other. Comparison of the obtained parameters of the sagittal balancein children with the data in scientific publications on the adult population revealed statistically significant differences in the values of 6 out of 10 of them.Conclusion. The age norms of the main parameters of the sagittal balance for children, and their gender differences were determined. Their difference from the normal parameters of the adult population was established, which requires that these features be taken into accountin clinical practice.

Analysis of somatometric parameters of children with recurrent subluxations of C1–C2 vertebrae

Introduction. The problem of instability in the cervical spine in children has been repeatedly discussed in the medical literature and has become the subject of discussion. This is due to a significant increase in the number and recurrence of subluxations in the C1–C2 segment. An assumption is made about the relationship of this pathology with systemic connective tissue dysplasia, but evidence-based studies are required.Aim. To make a statistical analysis of individual somatometric indicators in children with recurrent subluxations of the C1–C2 vertebrae and signs of connective tissue dysplasia.Materials and methods. The analysis of measurements of selected body parameters in pre-pubertal children with acute and recurrent torticollis against the background of systemic connective tissue dysplasia was carried out. The data of 186 children aged 9–11 years in comparative groups for the period 2016–2021 were studied. Modern methods of statistics were used.Results. Dependences were obtained confirming the hypothesis of the relationship between asthenic physique (high height, low weight and chest circumference) and recurrent dislocations in the C1–C2 segmentConclusions. When comparing the average values for two independent samples made up of the indicators of the main group and the comparison group, the conclusion obtained during visual examination and somatometric examination of patients diagnosed with torticollis at admission to the hospital was confirmed: relapses are inherent in children with high growth, low weight, smaller chest circumference and smaller wrist circumference.

Magnetic resonance imaging in acute traumatic injuries of ligaments and soft tissues of cervical spine in children

Aim of the study: to study the role and possibilities of magnetic resonance imaging (MRI) in the diagnosis of injuries of ligaments and soft tissues of the cervical spine in emergency care. Materials and methods. MRI was performed in fifty two children with trauma of the cervical spine, in 1 of them with contrast enhancement. Boys predominated - 33 (63.5%), girls were 19 (36.5%). The age of the patients varied from 3 to 17 years, the mean age was 14 ± 1.4 years. The study was carried out on a Phillips Achieva dStream 3T scanner. The study protocol includes MR-myelography in sagittal and coronary projections, T2WI sagittal projection in PS STIR, T2WI SE, T1WI SE, DTI, axial projection of T2WI SE or T2*WI GRE. Results. Trauma of cervical spine was combined in 46% (n = 24) of all 52 cases, and in 54% (n = 28) it was isolated. During the clinical and neurological examination according to the ASIA impairment scale, there were 13 (25%) children with grade A, 3 (5.8%) with grade B, 9 (17.3%) with grade C, 4 (7.7%) with degree D and 23 (44.2%) with grade E. Spinal cord injuries in the form of hematomyelia were detected in 13 (25%) children, contusion and swelling of the spinal cord - in 15 children (29%). According to MRI results, 4 (7.7%) had a traumatic hernia with a decrease in disc height, 15 (28.8%) had secondary stenosis of the spinal canal at the time of the study, 28 (53.8%) had spinal cord compression and changes in the MR signal, 5 (9.6%) had epi- and subdural hematomas, 45 (86.5%) had vertebral fractures. Conclusion. MRI, as a method more sensitive than other imaging modalities in the diagnosis of soft tissue and spinal cord injuries, allows radiologist directly assessing the condition of spine soft tissues and, therefore, is critical in the evaluation of a patient with ligament injury and instability. Recognition of soft tissue injuries affects patient management and outcome.

Prevertebral Soft Tissue Thickness of the Cervical Spine in Children: An Insensitive but Specific Aid in the Diagnosis of Occult Trauma.

The purpose of this study was to investigate the sensitivity and specificity of current cervical prevertebral soft tissue swelling (PVST) values in a cohort of children with known cervical fractures or dislocations. Forty two children (average age 11.9, range 1.4 to 17.0y) with documented cervical spine injury and 61 children (average age 11.9, range 0.5 to 17.9y) with cervical pain but no injury were reviewed (January 2004 to December 2015). PVST was measured on lateral cervical radiographs at C2, C3, and C6. Patients were stratified by age (0 to 2y, 3 to 6y, 7 to 10y, 11 to 15y, and 16y and above). The Wilcoxon rank sum test was used to compare PVST measurements at each spine level across injury and noninjury cohorts. Sensitivity and specificity were estimated to assess the ability of abnormal reference values to detect when a true injury was present. In addition, positive predictive value and negative predictive value were also estimated. The majority of c-spine injuries (31/42; 76%) involved bony fracture and 57% (24/42) were treated with a collar or brace. Comparison of PVST measurement found no difference at C2 ( P =0.07), C3 ( P =0.07), or at C6 ( P =0.99) across injury and non-injury cohorts. Sensitivity was poor at single-level measures for C2 (26%), C3 (31%), and C6 (24%), while specificity was relatively high (92%, 87%, and 79%, respectively). When an increased value at either C2 or C3 indicated injury, sensitivity increased to 36%, and when an increased measurement at just one of the 3 measured levels indicated injury, the sensitivity increased to 48%, while the specificity decreased to 72%. While retropharyngeal measures were more likely to detect injury than retrotracheal, C6 alone was increased in 5 of the 20 injury patients. PVST measurements exhibit poor sensitivity but good specificity as indicators for the diagnosis of occult cervical trauma in children. Negative values do not exclude injury; positive values suggest further evaluation. Level III.

Finite Element Analysis and Comparative Study of 4 Kinds of Internal Fixation Systems for Anterior Cervical Discectomy and Fusion in Children.

Background Spinal injury in children usually occurs in the cervical spine region. Anterior fixation of the lower cervical spine has been applied in treating pediatric cervical spine injury and disease due to its stable and firm mechanical properties. This study performed finite element analysis and comparison of four different anterior cervical internal fixation systems for children to explore more standard methods of anterior cervical internal fixation in children and seek more effective and safe treatment for children's cervical spine diseases. Methods A finite element model of 6-year-old children with lower cervical spine C4/5 discectomy was established, and the self-designed lower cervical spine anterior locking internal fixation system ACBLP and the children's anterior cervical internal fixation system ACOP, ACVLP, and ACSLP plate screws were fixed and loaded on the model. 27.42 N·m torque load was applied to each internal fixation model under six working conditions of anteflexion, backward flexion, left flexion, right flexion, left rotation, and right rotation, to simulate the movement of the cervical spine. The activity and stress distribution cloud diagram of each finite element model was obtained to explore the optimal method of anterior cervical fixation in children. Results In the four internal fixation models of ACOP, ACVLP, ACSLP, and ACBLP, the mobility of the C4/5 segment showed a decreasing relationship, and the mobility of adjacent segments increased significantly. In the Mises stress cloud diagram of the cervical spine of the four models, the vertebral body and accessories of the ACBLP model born the least stress, followed by ACSLP. The steel plate and screws in the ACVLP internal fixation model were the most stressed. The stress of the internal fixation system (plate/screw) in all models increased in the order of ACBLP, ACSLP, ACVLP, and ACOP. Conclusions ACBLP internal fixation system had obvious advantages in anterior internal fixation of the lower cervical spine in children, C4/5 had the smallest degree of movement, relative displacement was minimal, and the stress on the centrum and pedicle was the least, while the stress on the plate screw was relatively the smallest.

The state of blood flow of the main arteries of the head in children with neurocirculatory dysfunction and connective tissue dysplasia

BACKGROUND: The article studies the relationship between connective tissue dysplasia and neurocirculatory dysfunction. They are united by a systematic and multi-organ nature of complaints and violations. The frequency of occurrence of neurocirculatory dysfunction in connective tissue dysplasia depends on the severity of phenotypic signs and is 23.531.1%.
 AIM: The aim of this study is to evaluate the significance of the method of duplex scanning of the main cerebral vessels, as well as to evaluate the relationship of the obtained parameters with the data of neurosonography, radiography of the cervical spine in children with signs of neurocirculatory dysfunction and connective tissue dysplasia.
 MATERIALS AND METHODS: The duplex scanning method was used to study the main vessels of the neck that provide blood supply to the brain: common and internal carotid, vertebral arteries in 240 children hospitalized for somatic various diseases.
 RESULTS: The presence of diagnostically significant changes in the cervical spine was found in 111 of them (46.3%): hypoplasia of the CI or СII vertebrae with cranial subluxations, instability of the cervical spine, and juvenile osteochondrosis. In children diagnosed with neurocirculatory dysfunction without signs of connective tissue dysplasia, disturbances in the form of asymmetry of blood flow along the entire vertebral artery prevail in comparison with the comparison group. In patients with more pronounced signs of connective tissue dysplasia, structural features of the cervical spine (hypoplasia of the CI or СII vertebrae with cranial subluxations, instability, juvenile osteochondrosis) and impaired blood flow of the main arteries are significantly more common.
 CONCLUSIONS: According to the data of duplex scanning of the main arteries of the neck, disorders in the form of hemodynamically significant asymmetry of blood flow in the vertebral arteries at different levels are significantly more common. In patients with pronounced signs of connective tissue dysplasia, structural features of the cervical spine and impaired blood flow of the main arteries of the neck are significantly more common. The presence of connective tissue dysplasia may be one of the causes of the above disorders.

Diffusion tensor imaging in injuries of the cervical spine in children

Introduction. The technique of diffusion tensor imaging (DTI) is widely used in brain examination. However, DTI application for examining the spinal cord, especially in children, is not easy: small dimensions of the spinal cord with a typical low signal-to-noise ratio, artifacts from the respiration and pulsation of the heart and large vessels, as well as from swallowing movements. EPI sequences used to obtain diffusion indices cause eddy current distortions.Objective. To study changes in DTI parameters of the spinal cord in children with cervical spinal cord injury.Material and methods. 56 children aged 2–17 years with cervical spine injury (CSI) and 20 children without CSI were examined with Phillips Achieva3 T magnetic resonance scanner. The protocol consisted of sagittal STIR, sagittal and axial T1- and T2WI SE and axial DTI. To assess DTI, the following parameters were calculated: apparent diffusion coefficient (ADC), fractional anisotropy (FA), axial (AD) and radial (RD) diffusion coefficients.Results. By ASIA criteria, 29 (51%) children out of 56 had CSI with neurological complications; 27 (49%) had no complications. Neurological dysfunction of degree A was in 13 patients; B – in 3; C – in 9; D – in 4; E – in 27. Average values of diffusion in patients were: ADC = 0.74 ± 0.12 • 10−3 mm2/s−1, FA = 0.36 ± 0.07, BP = 1.15 + 0.28 • 10−3 mm2/s−1, RD = 0.52 + 0.32 • 10−3 mm2/s−1.Conclusion. DTI can detect changes which cannot be detected by conventional MRI. Low ADC values in the acute injury may indicate spinal cord injury and predict a negative functional outcome.

Impaired mobility of the upper cervical spine in children and adolescents

The article is based on the analysis of 185 cases of impaired mobility of the upper cervical spine. A classification of instability and hypomobility of the craniovertebral segment according to the etiological characteristic, mechanism, and severity of mobility impairment has been proposed. Clinical manifestations of instability and hypomobility are described. Clear criteria for diagnostics have been developed using functional radiography of the cervical spine and functional computed tomography of the C1 - C2 and CO - C1 segments. The state of blood circulation in the system of vertebral arteries was studied in this pathology. The indications for surgical and conservative treatment have been clarified.

Analysis of Upper Cervical Spine Measurements in the Uninjured Pediatric Spine.

Only a small number of studies have offered normative data for the upper cervical spine in children and with some variation in findings. The aim of this study was to determine normal values for upper cervical spine measurements used in the assessment of upper cervical spine trauma in the pediatric population. One-hundred computed tomographic images of the cervical spine of children aged ≤16 years were included for analysis. All children were cleared of spinal injury. Anterior atlanto-dens interval (ADI), posterior atlanto-dens interval (PADI), basion-dens interval (BDI), Powers ratio, condylar-C1 interval (CCI), and lateral mass interval (LMI) were measured on the relevant sagittal or coronal images. Measurements for CCI and LMI were taken on each side. Mean age was 111 months (range 11-196 months). Sixty-two were male. Mean values (and ranges) of the measurements were as follows: BDI: 7.1 mm (3.6-12.2); ADI 2.8 mm (0.8-4.8); PADI 18.7 mm (14.1-23.2); Powers ratio 0.72 (0.59-1.0); CCI 2.0 and 2.0 (0.5-4.2); and LMI 3.2 and 3.3 mm (1.7-4.8). BDI (r = -0.488), ADI (r = -0.201), PADI (r = 0.264), and CCI (r = -0.468 and -0.454) all showed significant correlation with age. The Powers ratio was the most stable measurement across all age groups. Normal values were reported from a local pediatric population with a wide age range. Most values correlate with age to a degree, and so normal values may vary throughout childhood. A multicenter study is desirable to advance knowledge in this field. Current radiographic measures used to assess for possible ligamentous injury in the pediatric upper cervical spine correlate with age. Caution must be held when analyzing the upper cervical spine across a range of age groups in children.

Three-Dimensional Morphology and Configuration Analyses of the Craniovertebral Junction in Children with Hemifacial Microsomia.

Observational and morphological study with three-dimensional (3D) computed tomography (CT) analysis. To discover the morphology and configuration deformities of craniovertebral junction (CVJ) and upper cervical spine in children with unilateral hemifacial microsomia (HFM). To determine whether there are specific HFM patients who are at higher risk of certain cervical vertebral anomaly. The evaluation for cervical vertebrae anomaly in HFM children, especially in CVJ region, is underreported. Eighty-eight unilateral HFM children (64 males, 24 females) with four Pruzansky-Kaban types (I, Ila, Ilb, and III) underwent cranial and cervical CT scanning from skull to C5 in neutral position. The 3D morphology and configuration of the occipital condyle, atlas, and axis, etc. were evaluated on the presence of deformed detailed structures of CVJ region. No C1 deformation was found in type I group. Six (14.3%) type Ila cases, seven (33.3%) type IIb cases, and six (37.5%) type Ill cases had lateral masses asymmetry of C1 (P < 0.05). Five (55.6%) type I cases, 17 (40.5%) type Ila cases, 12 (57.1%) type Ilb cases, and 10 (62.5%) type Ill cases had C2 anomaly (P > 0.05). The incidence rate of C1-C2 instability for four groups were 33.3% (type I), 33.3% (type IIa), 33.3% (type IIb), and 31.3% (type Ill), respectively (P > 0.05). For HFM children, the incidence of C1 deformation increased from type I to type Ill. The probability of C2 anomaly and C1-C2 instability in children with different types of HFM is nearly the same. The craniovertebral junction of every HFM child must be monitored carefully for C1-C2 instability before any surgical procedure to avoid atlantoaxial dislocation and spinal cord injury.Level of Evidence: N/A.

EFFECT OF DYSPLASTIC INSTABILITY OF THE CERVICAL SPINE ON THE FORMATION OF NEURORTHOPDIC PATHOLOGY IN CHILDREN

The article discusses the main causes of development and clinical features of the instability of the cervical spine in children of different ages. A clinical and instrumental study of 146 children was carried out to determine the relationshi p between dysplastic instability of the cervical spine and clinical manifestations of neuroorthopedic pathology. Risk factors for the formation of undifferentiated connective tissue dysplasia (UCTD) were identified, signs of osteoligamentous dysplasia on radiographs of the cervical spine and external phenotypic osteoarticular and muscle signs of UCTD in children with instability of the cervical spine were identified. Predicting the development of connective tissue dysplasia before the birth of a child with preventive measures, as well as early diagnosis of pathological conditions and timely treatment will prevent the formation of chronic somatic, neurological and orthopedic diseases.

Oncological and infectious destructive lesions of the cervical spine in children (literature review)

Objective: to analyze the current literature on tumors and osteomyelitis of the cervical spine in children. Design: a systematic literature review. Material and methods. Рublications were selected from the follow-ing scientific databases Pubmed, eLibrary.ru, Cochrane Library for the period from 2010 to 2021. The final sam-ple included 70 articles containing information about 187 children. Demographic data, clinical manifestations of diseases, features of diagnosis verification, surgical treatment and treatment results were analyzed. Re-sults. Тhe average age of patients in the sample was 9.4 years. The average duration of the diagnostic pause was 8.7 months. The most common complaint was neck pain; the most common etiological causes were tu-berculous spondylitis and benign tumors — 50% and 33%, respectively. Surgical treatment was performed in 81% of cases; the average duration of postoperative follow-up was 47.6 months. Conclusion. Destructive lesions of the cervical spine in children are rare. Sum-marizing these published articles allows to get a more complete picture of their clinical manifestations and treatment options.

Неосложненные переломы шейных позвонков у детей и подростков

Introduction Various aspects of uncomplicated fractures of the cervical vertebrae in children and adolescents remain topical. Purpose To study incidence, character and type of uncomplicated fractures of the vertebrae of the cervical spine in children and adolescents. Materials and methods Out of 1000 children who had uncomplicated vertebral fractures, 27 (2.7 %) people were diagnosed with fractures at the cervical level. There were more boys among the injured – 77.77 % of the injured. 29.63 % of the patients were under the age of 12, and 70.37 % of – aged 12–17. Traditional methods for emergency traumatology were used for clinical diagnostics. Results In 17 (62.96 %) of the patients only the cervical vertebrae were compressed, in 10 (37.04 %) patients – both the thoracic vertebrae and the cervical vertebrae. Among the cervical vertebrae, compression of C7 vertebral body was most often observed – in 30.64 % of cases, less often – the body of C3 – in 4.08 % of cases. The main mechanism of injury was falling on head from a height of 2 m and more – 25.98 % of cases. Analysis of the character of C2 fractures showed that four patients had fractures of the odontoid process (three patients – type I, one – type III), one patient – fractures of the arches of this vertebra corresponding to type I. Fractures of subaxial location mainly corresponded to group "A" (subgroup I (36 compressed vertebrae), subgroup II (6 injured vertebrae)). In 2 cases, vertebral fractures were referred to group "B" (subgroup I). In 25 (92.59 %) clinical cases conservative treatment was used, in 2 (7.41 %) – there were indications for surgical treatment. The average duration of in-patient treatment for fractures of the cervical vertebrae was 9.4 days. Evaluation of long-term treatment results showed "good" results in 83.33 % of cases, satisfactory – in 16.67 % of clinical observations. Discussion The results that we have received are mainly comparable with the literature data on the main aspects of cervical trauma in children. At the same time, it is necessary to mention some differences. For example, many authors report that younger children most often get fractures of the C2 vertebra. According to our data, the average age of patients with these fractures was 14.8 years.

Usefulness of ipsilateral translaminar C2 screws insertion for cervical fixation in children with a low laminar profile: a technical note.

The fusion of the upper cervical spine in children is demanding due to its reduced size, its anatomical complexity, or a severe pathology of the cranio-cervical junction. In some pediatric patients with today's more popular C1-C2 or, occipito-C2 techniques, it is impossible, or very risky to perform a short upper cervical fixation. We present the utility and good results of ipsilateral laminar C2 screws insertion technique in two pediatric cases with low C2 laminar profile. Case 1: a 5-year-old child with a C1-C2 unstable subluxation, and a condylar assimilation of C1, where we performed an occipito-C2 fixation using an occipital plate and this modified translaminar C2 screw technique. Case 2: a 8-year-old Down syndrome boy who suffered an unstable subluxation of C1-C2 upon whom we performed a C1-C2 screw fixation using the same technique. Both cases have been followed up over a period of 7 and 2 years respectively, with good clinical results. We describe the technique and the feasibility of the ipsilateral insertion of translaminar C2 screws in children with low laminar profiles, as a good alternative to other techniques when the anatomy of the C2 does not permit its use or make them very risky.

Have changes in computerised tomography guidance positively impacted detection of cervical spine injury in children? A review of the Trauma Audit and Research Network data

Background Clinically significant damage to the cervical spine in children is uncommon, but missing this can be life-changing for patients. The balance between rarity and severity leads to inconsistent scanning, with both resource and radiation implications. In 2014, the United Kingdom’s National Institute for Health and Care Excellence updated their computerised tomography neck imaging guidance in children. The aim of this study was to assess if the change in guidance had resulted in a change in diagnosis or imaging rates. Methods A retrospective review of the national Trauma Audit and Research Network’s data for computerised tomography spine imaging in children in 2012–2013 was compared to the same data sample collected in 2015–2016. Results The percentage of children presenting with neck trauma who were imaged reduced from 15.5 to 14.1% with an increase in confirmed cervical spine injury from 1.6 to 2.3% between the two time periods. The specificity of computerised tomography scanning increased from 10 to 16.4%. There was variation in scan rates, with major trauma centres scanning a greater percentage of children of all ages and with all injury scores, than trauma units. Discussion This study suggests national guidance can impact clinical care in a relatively short timeframe. Variation in how guidance is applied, with major trauma centres scanning proportionately more children with a lower yield, could be because scanning is more readily available, or because trauma protocols encourage more scans. Twenty per cent of injuries were not found on the initial computerised tomography, in keeping with previously reported data, because the injuries were ligamentous or cord contusion. This suggests a role for early magnetic resonance imaging in children with suspected spinal injury.