Severe sprains of the sub-axial cervical spine in adolescents: a diagnostic and therapeutic challenge

McLoughlin, Lisa; Jadaan, Mutaz; McCabe, John P.

doi:10.1007/s00586-013-2794-5

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…However, flexion-distraction injuries without bone fracture are not common at C2-C3 (Jubert et al 2013). A clinical study reported a few cases of "flexion sprain" at C2-C3 in adolescents causing important post-traumatic dynamic instability: antero-posterior translation of 4 to 4.5 mm and C2-C3 rotation flexion of 13 to 15 degrees measured on dynamic flexion-extension X-Rays (McLoughlin et al 2014). These results are similar to what we observed at C2-C3 (antero-posterior translations of 4 and 9 mm and local ROM ranging from 8.6 to 19.4).…”

Section: Discussionmentioning

confidence: 99%

“…At complete disc rupture, this high anterior displacement combined with high local rotation lead to an important change in the antero-posterior position of the C2-C3 facets. This could lead to luxation and compression of the spinal cord (McLoughlin et al 2014). This phenomenon was observed for a non-traumatic flexion moment (2 Nm) which shows the importance of post-traumatic immobilization in comparison.…”

Section: Discussionmentioning

confidence: 99%

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Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine

Beauséjour

Petit

Hagen

et al. 2020

Computer Methods in Biomechanics and Biomedical Engineering

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Posterior ligamentous complex (PLC) and intervertebral disc (IVD) injuries are common cervical spine flexion-distraction injuries, but the residual stability following their disruption is misknown. The objective of this study was to evaluate the effect of PLC and IVD disruption on post-traumatic cervical spine stability under low flexion moment (2 Nm) using a finite element (FE) model of C2-T1. The PLC was removed first and a progressive disc rupture (one third, two thirds and complete rupture) was modeled to simulate IVD disruption at C2-C3, C4-C5 and C6-C7. At each step, a non-traumatic flexion moment was applied and the change in stability was evaluated. PLC removal had little impact at C2-C3 but increased local range of motion (ROM) at the injured level by 77.2% and 190.7% at C4-C5 and C6-C7 respectively. Complete IVD rupture had the largest impact on C2-C3, increasing C2-C3 ROM by 181 % and creating a large anteroposterior displacement of the C2-C3 segment. The FE analysis showed PLC and disc injuries create spinal instability. However, the PLC played a bigger role in the stability of the middle and lower cervical spine while the IVD was more important at the upper cervical spine. Stabilization appears important when managing patients with soft tissue injuries.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine

Beauséjour

Petit

Hagen

et al. 2020

Computer Methods in Biomechanics and Biomedical Engineering

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“…Sprains to the subaxial cervical spine in adolescents have been reported from our institution previously. McLoughlin et al [5] demonstrated that it is possible to have a severe sprain of the C-spine in an adolescent, causing significant C-spine instability with an intact PLL and annulus at the injured level. Therefore, PLL integrity in an adolescent spine does not indicate stability.…”

Section: Discussionmentioning

confidence: 99%

Sprain of the Subaxial Cervical Spine in Childhood

Lyons

McSorely

Jadaan

et al. 2018

Case Reports in Orthopedics

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Posterior atlantoaxial ligament disruption in children is a rare diagnosis. We present a case of a young girl with cervical spine posterior atlantoaxial ligament disruption post a fall from a climbing frame. Presenting with minimal symptoms other than neck pain, this case highlights the diagnostic difficulty and need for further radiological imaging in paediatric patients with neck pain post trauma.

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C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

Alexander

Dowlati

McGowan

et al. 2019

Spinal Cord Ser Cases

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Introduction Spinal cord injury is one of the leading causes of paralysis and permanent morbidity. High cervical spine injuries, in particular, have the potential to be fatal and debilitating due to injury to multiple components, including but not limited to, discoligamentous disruption, vascular insult and spinal cord injury. To date, no unifying algorithm exists making it challenging to guide treatment decisions. Case presentation We present the case of a 29-year-old polytrauma patient with an unstable C2-C3 fracture subluxation secondary to hyperextension and rotation injury with complete ligamentous dissociation and vertebral artery dissection after a high-velocity injury. We review the literature on injury patterns, associated complications and neurological outcomes in subaxial cervical spine injuries. Discussion Our patient's injuries had several components including fracture subluxation, ligamentous disruption, central cord syndrome, and vascular insult. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. Our patient underwent an open anterior C2-C3 reduction and discectomy with fusion and plating and a subsequent C2-C4 posterior instrumented fusion. The patient regained some motor function postoperatively and through rehabilitation. Careful consideration of multiple components is crucial when treating subaxial spine injuries.

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Severe sprains of the sub-axial cervical spine in adolescents: a diagnostic and therapeutic challenge

Abstract: We report three cases of adolescents with severe cervical sprains at the C2-C3 level and argue the integrity of PLL as a determinant factor in the sagittal stability of the C spine in this age group.

Cited by 3 publications

References 6 publications

Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine

Contribution of injured posterior ligamentous complex and intervertebral disc on post-traumatic instability at the cervical spine

Sprain of the Subaxial Cervical Spine in Childhood

C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

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