Cervical Spine In Children Research Articles

Roentgenographical study of the stability of the cervical spine in children.

A roentgenographical study of the supposedly normal cervical spine in 40 children is reported. At the upper cervical level, the validity of the criteria in the literature (especially the atlantodental distance on the lateral view) was confirmed, and an upper limit was determined for children. A study of the atlantoaxial relationship on the anteroposterior view in neutral position and in lateral position was performed. At the lower cervical level, measurements according to Penning (Am J Roentgenol 1978;30:317-26) and Cattel and Filtzer (J Bone Joint Surg [Am] 1965;47:1295-308) were applied to children and compared level by level at each age. This study allows a better comprehension of the mobility of the cervical spine in children and offers an explanation for suspicious roentgenographical features after trauma.

The surgical treatment of instability of the upper part of the cervical spine in children and adolescents.

Low back pain is the most common complaint expressed by adult patients in the primary care setting, and the incidence of low back pain in adolescents is rising. Adolescents who are involved in athletics most commonly suffer from spondylolysis, spondylolisthesis, mechanical low back pain, and herniated disks, whereas adult athletes most commonly suffer from lumbosacral strain and herniated or degenerative disks. Initial nonsurgical management aims to reduce inflammation and noninvasively strengthen damaged tissues. Although most patients who have low back pain will return to sports after nonsurgical treatment, surgery may be required in patients who have persistent or progressive neurologic symptoms.

Fusion for Instability and Potential Instability of the Cervical Spine in Children and Adolescents

Instability and potential instability of the cervical spine in the child and adolescent not presenting as emergencies may be due to many causes. We have reviewed 30 patients treated surgically over a seven year period and have grouped them under four general headings: isolated congenital anomalies of the cervical spine, postlaminectomy instability, traumatic instability with delayed presentation, and bony or ligamentous inadequacy secondary to miscellaneous conditions. The variety of conditions permits few generalizations. However, an overview of the entire group supports the concept that abnormal motion in an immature spine or the potential for such motion should be viewed cautiously by the orthopedist, for it may herald severe neurologic compromise. When compromise has occurred, the decision to intervene is made easier. Should only increased motion or the potential for such be present, the natural history of the lesion, if available, should be the guide to treatment. If the natural history of a cervical spine lesion is not available and structural integrity is compromised with abnormal motion present, fusion is advised. Appropriate patient counseling as to the lack of an alternative, with the exception of prolonged bracing to avoid the hazards of life, is essential in this group of individuals.

Fractures and Dislocations of the Cervical Spine in Children

Correct diagnosis of fractures and dislocations of the cervical spine in children requires an awareness of the pseudosubluxation and other normal variants noted in x-ray films of patients in this age group. Fractures of the odontoid process occur frequently and almost always can be treated by closed reduction and external fixation until union occurs. Fractures of the lower cervical spine are difficult to detect roentgenographically, and x-ray changes can belie the severity of soft tissue injury and cord trauma. Instability tends to persist in adolescent patients after cervical spine injury because of the combination of epiphyseal and posterior ligamentous disruption. Neoplastic, inflammatory, and congenital lesions render the cervical spine vulnerable to injury and can permit major damage to result from minor stress.

Arthrodesis of the cervical spine in children

Arthrodesis of the cervical spine in children

Pseudosubluxation and Other Normal Variations in the Cervical Spine in Children

There are several diagnostic pitfalls in the interpretation of roentgenograms of the cervical spine in children with suspected neck injuries. Incomplete ossification, epiphyscal variations, unique bone architecture, and relative hypermobility may all contribute to possible diagnostic errors. In this study of 160 normal children's cervical spines, the following suspect normal variations were observed: 1. Variations due to displacement of vertebrae that may resemble subluxation: Marked anterior displacement of the second on the third cervical vertebra, resembling a true subluxation, was observed in 19 per cent of the children studied who were one to seven year old. A similar finding was present less frequently between the third and fourth cervical vertebrae. Overriding of the atlas on the odontoid process, seen on lateral roentgenograms made with the neck in extension, and apparrent wedening of the space between these two structures, visible on flexion views, occurred in 20 per cent of the normal children between one and seven years of age. Both were suggestive of ligamentous injury. 2. Variations of curvature of cervical spine that may resemble spasm and ligamentous injury: Absence of uniform angulation between adjacent vertebrae, absence of the normal lordotic curve in neutral position, and absence of a flexion curvature of the spine between the second and the seventh cervical vertebrae, seen on lateral roentgenograms made with the cervical spine in flexion, were seen at all ages between one and sixteen years, the incidence of each variation ranging between 14 and 16 per cent. 3. Variations related to skeletal growth centers resembling fractures: The presence of the basilar odontoid cartilaginous plate frequently persists in vestigial form until the age of five years or longer and may resemble an undisplaced fracture. The apical odontoid epiphysis is rarely seen on lateral roentgenograms, but should not be mistaken for a fracture. A secondary ossification center of a cervical spinous process was seen only once in this study; there was no resemblance to an avulsion fracture. A center of ossification in the first thoracic spinous process, however, did have some resemblance to a fracture. This variation would not appear to be a pitfall in the diagnosis of neck injury in children and adolescents. Physicians responsible for the care of children with neck injuries should be conversant with the normal roentgenographic variations.

Hypermobility of the cervical spine in children: A pitfall in the diagnosis of cervical dislocation

Subluxation of the cervical vertebrae not associated with fracture occurs frequently in children. Three types are recognized, namely, spontaneous atlantoaxial dislocation, unilateral suboccipital dislocation and rotary unilateral subluxation below the second cervical vertebra. Pain, torticollis, muscular spasm and limitation of motion almost always accompany these types of subluxation. Hypermobility of the second and third cervical vertebra, or apparent subluxation, also is encountered frequently in children and is a normal variation. In a roentgenographic study, fifteen of 100 normal children had a “step-off” between the second and third or the third and fourth cervical vertebrae of 3.5 or 4 mm. Unless the roentgenographic interpretation is confirmed by the physical signs of genuine subluxation, overtreatment by means of prolonged traction or immobilization in a cast may be carried out under the misconception that serious injury exists.

Two Cases of Dislocation of the Cervical Spine in Children Caused by Hyperæmic Decalcification of the Vertebræ following Cervical Adenitis

Two Cases of Dislocation of the Cervical Spine in Children Caused by Hyperæmic Decalcification of the Vertebræ following Cervical Adenitis