Brook’s Wiring for Treatment of an Atlanto-Axial Dislocation and Odontoid Fracture in a Child

Abstract

IntroductionCervical spine injuries are rarely seen in children with an overall incidence of about 1-1.5%. 1,2 In pediatric cervical spine injury, the upper cervical spine is the most common site affected (52% of cases). 2The typical injury mechanisms for pediatric cervical spine injuries are hyper flexion movements as in motor vehicle accidents, because of distinct anatomic properties of a child's body, like an increased head-to-body ratio. 3,4 We here report the case of a 5-year-old boy, who sustained a severe hyperflexion trauma of the cervical spine in a highspeed car accident (approx. 60 mph). Computed tomography (CT) and magnetic resonance imaging (MRI) showed a complete atlanto-axial dislocation with synchondrotic fracture of the odontoid process. Case historyIn February 2013, a 5-year-old boy was a restrained passenger in a high-speed car crash with presumed high-force impact. Neither initial nor delayed unconsciousness were reported. He was responsive on scene, with neck pain and loss of head rotation. He was immobilized with stiff neck and spine-board and admitted to the emergency department of our hospital. DiagnosisExamination showed a glascow coma score (GCS) of 15 with pupils equal, round, reactive to light and accommodation. He was responsive and alert on scene but couldn't remember what has happened. The primary survey showed no disabilities or signs of head, chest, abdominal, pelvic or extremity injury. Both loss of head rotation and neck pain persisted. No abdominal damage aroused from sonographic assessment. We decided to perform a computed tomography (CT) of his head and neck to rule out intracerebral bleeding and fractures. Standard and 3D reconstructions revealed an atlanto-axial dislocation with a displacement of the atlas >5mm, a fracture of the odontoid process with a ventral axis tilt of 22° (Figure 1) and no signs of intracerebral bleeding. A following MRI scan Figure 2 showed ruptures of the interspinous ligaments from C2 to C6 with intact alar ligaments. The spinal cord showed no signs of damage. These findings lead to the diagnosis of an atlanto-axialdislocation with synchondrotic fracture of the odontoid process in a neurologically intact 5-year-old boy. AbstractBackground: Upper cervical spine injuries are rarely seen in children. Distinct anatomic properties make head and neck susceptible to hyperflexion movements.

Covid-19 – Manifestações Neurológicas – Guillain-Barré

“…Nessas lesões o fator desencadeante são os traumas de alta intensidade como acidentes automobilísticos e quedas de grandes alturas. (SCHICHO;RIEPL;SCOLA, 2015). É observado também esse tipo de injúria cervical em pacientes idosos, nestes a fratura normalmente é causada por queda da própria altura tendo como agravante o processo de descalcificação óssea natural da senescência.…”

A Clinical Study to Assess the Efficacy of Anterior Transarticular C1-C2 Screw Fixation for Stabilization of AtlantoAxial Instability

“…Common causes of Atlanto-axial instability include trauma, tumour, rheumatoid arthritis, infection and congenital anomalies 2 . Historically,clinically or radiological significant Atlanto-axial subluxation is traditionally treated by reduction and fusion of C1-C2 joint by wiring method which includes Gallie's fusion with Halifax clamps 3 , Brooks method along with Jenkins fusion 4 , Sonntag posterior C1-C2 technique 5 and Magerl technique 6 which comprises of posterior trans-articular screw fixation along with bone graft. Currently, Goel's and Harm's technique 7 has been popular amongst spine surgeons.…”