Download PDF
Indian Journal of Neurotrauma 2007; 04(02): 79-87
DOI: 10.1016/S0973-0508(07)80021-9
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Craniovertebral junction injuries in children. A Review

Abrar Ahad Wani
,
Tanveer A Dar
,
Altaf Umar Ramzan
,
Altaf Rehman Kirmani
,
Abdul Rasheed Bhatt
Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Also available at
  PDF Download  Permissions and Reprints

Abstract

The craniovertebral junction (CVJ) is the most complex and dynamic region of the cervical spine. The wide range of movements possible at this region makes it vulnerable to injury and instability. The special anatomical features make children more prone to injuries of CVJ than adults where lower cervical spine is involved more frequently. The classical clinical manifestation in CVJ injury patients are pyramidal signs including weakness and spasticity, stigmata of CVJ anomalies (short neck, low hair line, facial or hand asymmetry, high arched palate, ), torticolis and neck movement restriction. The history of transient loss of consciousness or sudden neurological deterioration following minor trauma may be elicited. Most authors advocate conservative management (in form of immobilization) of CVJ injuries in children as is true in adults. Halo vest provides superior immobilization in upper cervical and CVJ injuries and can be used in a child as young as 1 year of age with minimal difficulty. Early surgical intervention, i.e. within 2 weeks of injury include is indicated in injuries that cannot be reduced and stabilized by external means, partial spinal cord injury with progressive neurological deficit and in children with extradural hematoma.

Keywords

Craniovertebral junction - fracture - children
 

  • References

  • 1 White III AA, Panjabi MM. The basic kinematics of the human spine: A review of past and current knowledge. Spine 03 1978; 12-20
    CrossrefPubMedGoogle Scholar
  • 2 Vogel LC. Unique management needs of pediatric spinal cord injury patients: Etiology and pathophysiology. J Spinal Cord Med 20 1997; 10-13
    PubMedGoogle Scholar
  • 3 MacKinnon JA, Perlman M, Kirpalani H, Rehan V, Sauve R, Kovacs L. Spinal cord injury at birth: Diagnostic and prognostic data in twenty-two patients. J Pediatr 122 1993; 431-437
    CrossrefPubMedGoogle Scholar
  • 4 Ruge JR, Sinson GP, McLone DG. et al Traumatic anterior atlanto-occipital dislocation. Neurosurgery 04 1979; 12-17
    CrossrefPubMedGoogle Scholar
  • 5 Givens TG, Polley KA, Smith GF. et al Pediatric cervical spinal injury: a three year experience. J Trauma 41 1990; 310-314
    PubMedGoogle Scholar
  • 6 Hadley MN, Zabramski JM, Browner CM. et al Pediatric spinal trauma. Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68 1988; 18-24
    CrossrefPubMedGoogle Scholar
  • 7 Heffez DS, Ducker TB. Fracture and dislocations of the pediatric spine. in Pang D. (ed): Disorders of the Pediatric Spine. 1995. Raven Press; New York: 517-529
    Google Scholar
  • 8 Hill SA, Miller cA, Kosnik EJ. et al Pediatric neck injuries. Clinical study. J Neurosurg 60 1984; 700-706
    CrossrefPubMedGoogle Scholar
  • 9 Powers B, Miller MD, Kramer RS. et al Traumatic anterior atlanto-occipital dislocation. Neurosurgery 04 1979; 12-17
    CrossrefPubMedGoogle Scholar
  • 10 Cattell HS, Filtzer DL. Pseudosubluxation and other normal variations in the cervical spine in children. J Bone Joint Surg 47A 1965; 1295-1309
    PubMedGoogle Scholar
  • 11 Andrews LG, Jung SK. Spinal cord injuries in children in British Columbia. Paraplegia 17 1979; 442-451
    CrossrefPubMedGoogle Scholar
  • 12 Osenbach RK, Menezes AH. Spinal cord injury without radiographic abnormality in children. Pediatr Neurosci 15 1989; 168-175
    CrossrefPubMedGoogle Scholar
  • 13 Pang D, Wilberger JE. Spinal cord injury without radiographic abnormalities in children. J Neurosurg 57 1982; 114-129
    CrossrefPubMedGoogle Scholar
  • 14 Scott YR Ahimi, Andrew Stevens, John Yeh, Ann Marie Flannery, Haroon Fiaz Choudhri and Mark R.Lee. Treatment of atlantoaxial instability in pediatric patients. Neurosurg Eocus 2003; 15(6): Clinical Pearl 1.
    PubMed
  • 15 Anderson JM, Schutt AH. Spinal injury in children. A review of 156 cases seen from 1950 through 1978. Mayo Clin Proc 55 1980; 499-504
    PubMedGoogle Scholar
  • 16 Burke DC. Traumatic spinal paralysis in children. Paraplegia 11 1976; 268-276
    PubMedGoogle Scholar
  • 17 Henrys P, Lye ED, Lifton C, Salciccioli G. Clinical review of cervical spine injuries in children. Clin Orthop 129 1977; 172-176
    CrossrefPubMedGoogle Scholar
  • 18 Hadley MN, Zabramski J, Browner CM, Rekate H, Sonntag V. Pediatric spinal trauma: Review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 68 1988; 18-24
    CrossrefPubMedGoogle Scholar
  • 19 Hadley MN, Browner CM, Sonntag VKH. Axis fractures: A comprehensive review of management and treatment in 107 cases. Neurosurgery 17 1985; 281-290
    CrossrefPubMedGoogle Scholar
  • 20 Hart R, Saterbak A, Rapp T, Clark C. Nonoperative management of dens fracture nonunion in elderly patients without myelopathy. Spine 200;25:1339–43.
    PubMed
  • 21 Lennarson PJ, Mostafavi H, Traynelis VC, Walters BC. Management of type II dens fractures: A case control body. Spine 25 2000; 1234-1237
    CrossrefPubMedGoogle Scholar
  • 22 Anderson LD, D’Alonzo RT. Fractures of the odontoid process of the axis. J Bone Joint Surg 56A 1974; 1663-1674
    PubMedGoogle Scholar
  • 23 Hadley Mark N.. Management of combination fractures of the atlas and axis in adults. Neurosurgery 50 2002; 140-147
    CrossrefPubMedGoogle Scholar
  • 24 Osenbach Richard K, Menezes Arnold H. Pediatric spinal cord and vertebral column injury: Experimental and clinical study. Neurosurgery 30 2002; 385-390
    PubMedGoogle Scholar
  • 25 David Fiarholm, Tseng Lee Shih, Nyar Lui Tai. Fractured odontoid: The management of delayed neurological symptoms (Clinical studies). Neurosurgery 38 1996; 38-43
    CrossrefPubMedGoogle Scholar
  • 26 Griffiths SC. Fracture of the odontoid process in children. J Pediatr Surg 07 1972; 680-683
    CrossrefPubMedGoogle Scholar
  • 27 Menticoglou SM, Perlman M, Manning FA. High cerfical spinal cord injury in neonates delivered with forceps: Report of 15 cases. Obstet Gynecol 86 1995; 589-594
    CrossrefPubMedGoogle Scholar
  • 28 Kirankumar Markani V, Sanjay Behari, Salunke P, Banerji D, Chhabra DK, Jain VK. Surgical management of remote, isllated type II odontoid fractures with atlantoaxial dislocation causing cervical compressive myelopathy. Neurosurgery 56 2005; 1004-1012
    PubMedGoogle Scholar
  • 29 El-Khoury GY, Clark CR, Gravett AW. Acute traumatic rotatory atlanto axial dislocation in children: A report of three cases. J Bone Joint Surg 66A 1984; 774-777
    PubMedGoogle Scholar
  • 30 Kowalski HM, Cohen WA, Cooper P, Wisoff JH. Pitfalls in the CT diagnosis of atlantoaxial rotary subluxation. Am J Roentgenol 149 1987; 595-600
    CrossrefPubMedGoogle Scholar
  • 31 Phillips WA, Hensinger RN. The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg 71A 1989; 664-668
    PubMedGoogle Scholar
  • 32 Subach BR, McLaughlin MR, Albright AL, Pollack IF. Current management of pediatric atlantoaxial rotatory subluxation. Spine 23 1998; 2174-2179
    CrossrefPubMedGoogle Scholar
  • 33 Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation: Fixed rotatory subluxation of the atlanto-axial joint. J Bone Joint Surg 59A 1977; 37-44
    PubMedGoogle Scholar
  • 34 Lui TN, Lee ST, Wong CW, Yeh YS, Tzaan WC, Chen TY, Hung SY. C1–C2 fracture dislocations in children and adolescents. J Trauma 40 1996; 408-411
    CrossrefPubMedGoogle Scholar
  • 35 Glausauer FE, Cares HL. Biomechanical features of traumatic paraplegia in infancy. J Trauma 13 1973; 166-170
    CrossrefPubMedGoogle Scholar
  • 36 Papavasilou V. Traumatic subluxation of the cervical spine during childhood. Orthop Clin N Am 09 1978; 945-954
    PubMedGoogle Scholar
  • 37 Ahmann PA, Smith SA, Schwartz JF, Clark DB. Spinal cord infarction due to minor trauma in children. Neurology 25 1975; 301-307
    CrossrefPubMedGoogle Scholar
  • 38 Chesire DJE. The pediatric syndrome of traumatic myelopathy without demonstratable vertebral injury. Paraplegia 15 1977; 74-85
    CrossrefPubMedGoogle Scholar
  • 39 Corner EM. Rotary dislocation of the atlas. Ann Surg 45 1907; 9-26
    CrossrefPubMedGoogle Scholar
  • 40 Adams CBT, Logue V. Studies in cervical spondylotic myelopathy. Neurosurgery 38 1996; 38-43
    CrossrefPubMedGoogle Scholar
  • 41 Kamman GR. Recurring atlo-axial dislocation with repeated involvement of cord and recovery. JAMA 112 1939; 2018-2022
    CrossrefPubMedGoogle Scholar
  • 42 Schewarz GA, Wigton RS. Fracture dislocation in the regions of the atlast and axis, with consideration of delayed neurological manifestations and some roentenographic features. Radiology 28 1937; 601-607
    CrossrefPubMedGoogle Scholar
  • 43 Ruge JR, Sinson GP, McLone DG, Cerullo LJ. Pediatric spinal injury: The very young. J Neurosurg 68 1988; 25-30
    CrossrefPubMedGoogle Scholar
  • 44 Huerta C, Griffith R, Joyce SM. Cervical spine stabilization in pediatric patients: Evaluation of current techniques. Ann Emerg Med 16 1987; 1121-1126
    CrossrefPubMedGoogle Scholar
  • 45 Shafermeyer RW, Ribbeck BM, Gaskins J. et al .Respiratory effects of spinal immobilization in children. Ann Emerg Med 20 1991; 1017-1019
    CrossrefPubMedGoogle Scholar
  • 46 Pang D, Hanley EN. Special problems of spinal stabilization in children. In: Cooper PR. (Eds) Management of Posttraumatic Spinal Instability (Neurosurgical Topics No. 3). 1990. AANS; Park Ridge: 181-206
    Google Scholar
  • 47 Aufdermaur M. Spinal injuries in juveniles. Necropsy findings in twelve cases. J Bone Joint Surg 56B 1974; 513-519
    PubMedGoogle Scholar
  • 48 Cooper PR, Cohen W. Evaluation of cervical spinal cord injuries with metrizamide myelography-CT scanning. J Neurosurg 61 1984; 281-289
    CrossrefPubMedGoogle Scholar
  • 49 Laham JL, Cotcamp DH, Gibbons PA, Kahana MD, Crone KR. Isolated head injuries versus multiple trauma in pediatric patients: Do the same indications for cervical spine evaluation apply?. Pediatr Neurosurg 21 1994; 221-226
    CrossrefPubMedGoogle Scholar
  • 50 Bohn D, Armstrong D, Becker L, Humphreys R. Cervical spine injuries in children. J Trauma 30 1990; 463-466
    CrossrefPubMedGoogle Scholar
  • 51 Viccelio P, Simon H, Pressman BD, Shah MN, Mower WR, Hoffman JR. A prospective multicenter study of cervical spine injury in children. Pediatrics 108 2001; E20
    CrossrefPubMedGoogle Scholar
  • 52 Swischuk LE, John SD, Hendrick EP. Is the open mouth odontoid view necessary in children under 5 years?. Pediatr Radiol 30 2000; 186-189
    CrossrefPubMedGoogle Scholar
  • 53 Scarrow AM, Levy EI, Resnick DK, Adelson PD, Sclabassi RJ. Cervical spine evaluation in obtunded or comatose pediatric trauma patients: A pilot study. Pediatr Neurosurg 30 1999; 169-175
    CrossrefPubMedGoogle Scholar
  • 54 Ralston ME, Chung K, Barnes PD, Emans JB, Schutzman SA. Role of flexion-extension radiographs in blunt pediatric cervical spine injury. Acad Emerg Med 08 2001; 237-245
    CrossrefPubMedGoogle Scholar
  • 55 Dwek JR, Chung CB. Radiography of cervical spine injury in children: Are flexion-extension radiographs useful for acute trauma?. Am J Roentgenol 174 2000; 1617-1619
    CrossrefPubMedGoogle Scholar
  • 56 Hadley Mark N. Management of pediatric cervical spine and spinal cord injuries. Neurosurgery 50 2002; 85-89
    CrossrefPubMedGoogle Scholar
  • 57 Shaw M, Burnett H, Wilson A, Chan O. Pseudosubluxation of C2 on C3 in polytraumatized children: Prevalence and significance. Clin Radiol 54 1999; 377-380
    CrossrefPubMedGoogle Scholar
  • 58 Sherk HH, Nicholson JT, Chung SM. Fracture of odontoid process in young children. J Bone Joint Surg 60A 1978; 921-924
    PubMedGoogle Scholar
  • 59 Bracken MB, Shepard MJ, Collins wF. A randomized trial of methyl-prednisolone or naloxone in the treatment of acute spinal cord injury. N Engl J Med 322 1990; 1405-1411
    CrossrefPubMedGoogle Scholar
  • 60 Dickman CA, Hadley MN, Browner C, Sontag VKH. Neurosurgical management of acute atlast-axis combination fractures: A review of 25 cases. J Neurosurg 70 1989; 45-49
    CrossrefPubMedGoogle Scholar
  • 61 Lee TT, green BA, Petrin DR. Treatment of stable burst fracture of the atlas (Jefferson fracture) with rigid cervical collar. Spine 23 1998; 1963-1967
    CrossrefPubMedGoogle Scholar
  • 62 Henry AD, Bohly J, Grosse A. Fixation of odontoid fractures by an anterior screw. J Bone Joint Surg 81B 1999; 472-477
    PubMedGoogle Scholar
  • 63 Fielding JW, francis Jr wR, Hawkins RJ, Pepin J, Hensinger R. Traumatic spondylolisthesis of the axis. Clin Orthop 239 1989; 47-52
    PubMedGoogle Scholar
  • 64 Crockard HA, Heilman AE, Stevens JM. Progressive myelopathy secondary to odontoid fractures: Clinical, radiologic and surgical features. J Neurosurg 78 1993; 579-586
    CrossrefPubMedGoogle Scholar
  • 65 Mandabach M, Ruge JR, Hahn YS, McLone DG. Pediatric axis fractures: Early halo immobilization, management and outcome. Pediatr Neurosurg 19 1993; 225-232
    CrossrefPubMedGoogle Scholar
  • 66 Reinges HM, Mayfrank L, Rohde V, Spetzler U, Gilsbach JM. Surgically treated traumatic synchondrotic disruption of the odontoid process in a 15 month old girl. Childs Nerv Syst 14 1998; 85-87
    CrossrefPubMedGoogle Scholar
  • 67 Wang J, Vokshoor A, Kim S, Elton S, Kosnik E, Bartkowski H. Pediatric atlantoaxial instability: Management with screw
    PubMed