Fracture of the Anterior Arch of Atlas After Minor Trauma of the Immature Spine Postlaminectomy

Abstract

Torticollis is a common complaint in the pediatric emergency department. Here, we report what we believe to be the first example in a young child of a fracture of the anterior arch of the atlas associated with an acquired, postsurgical defect of the posterior arch. A brief review of pediatric cervical spine injuries and fractures is presented. Atlas laminectomy may predispose patients to isolated atlas fractures even with minor trauma. Those fractures, however, are stable and treated by hard cervical orthosis.

Delayed diagnosis of fractured anterior arch of the atlas in a young child

“…Although it is reasonable to keep radiation exposure as low as possible, further investigations should always be considered in the case of unremarkable X-rays with persisting neck pain and limited range of neck motion 23. Our patient did not demonstrate any prevertebral soft tissue swelling, an indirect sign of a fracture of the C-spine, on plain X-ray images 24. Therefore, we decided to perform an MRI of the C-spine in accordance with the suggestion of Judd et al 25 to further assess the integrity of the atlantal ligament.…”

Spontaneous anterior arch fracture of the atlas following C1 laminectomy without fusion: A report of three cases and finite element analysis

“…It is not easy to clearly define treatment for anterior arch fracture of the atlas. Two of our cases (case 1 and case 3) and one pediatric case in the literature (case 7 in Table 3) [9] were treated conservatively. Our two conservatively treated cases did not demonstrate bony union, although the patients remained asymptomatic for at least 15 and 30 months, respectively, after the fracture.…”

Anterior Atlas Fracture After C1 Laminectomy Which Was Successfully Treated by Brace Therapy

“…(2) O'Shaughnessy et al 5 reported 2 cases of C1 laminectomies for Chiari malformation type I as follows: an 18-year-old female patient who was treated with a C1-C2 fusion and a 49-year-old female patient who was treated with bone morphogenetic protein (BMP) 2 through a standard anterior cervical incision, followed by the placement of an orthotic halo for 3 months. (3) Baghdassarian et al 6 reported a case of a 4-year-old female patient who underwent a C1 laminectomy for the removal of cerebellar astrocytoma 4 months earlier. She underwent brace therapy using a Miami-J orthosis, thereby achieving bone union.…”