Non-contiguous Cervical Spine Injury in a 14-month old Child;Case Report and Review of the Literature

Abstract

Introduction

Cervical spine injuries in children are relatively rare. Pattern, severity and level of these injuries are age dependant. Most of the available literature differentiates between two age groups, younger and older than 8 years. The incidence of upper cervical injuries is higher among children younger than 8 years. Most of the available literature is retrospective analysis of databases or case reports.

Patients and Methods: a 14-month old child was presented to our emergency unit after involvement in a road-traffic accident. A stiff neck cervical collar was applied at the accident scene. The child was conscious, oriented. He had tendency to move the right upper and lower limb better than the left side. He had torticollis with the head rotated to the left side. Neurological examination revealed a left-sided hemiparesis. He had no other injuries. Under general anesthesia CT and MRI of the skull and the cervical spine were done. These investigations showed a fracture of the axis with a rotary subluxation of C1/2, cord edema at the level of C1 predominantly on the left side and a disco-ligamentous injury at the level of C3/4. Controlled closed reduction under image intensifier and Minerva cast was applied for 3 weeks, and then replaced with a modified Minerva-Hartmann orthosis for another 3 weeks. A review of the literature for patients below the age of 3 years with cervical spine injuries was done in a trial to define an algorithm to clear the cervical spine and to outline the management of this age group.

Results

The patient was followed for one year with normal MRI findings at 6 months and normal clinical findings at one year follow-up with complete improvement of the neurological deficits.

Conclusion

Clearance of the cervical spine after trauma in children below the age of 3 is challenging. Articulation and cooperation during clinical examination and imaging investigation is limited. Imaging should be done under general anesthesia. Immobilisation is also demanding and definitive immobilisation for conservative treatment is usually using custom-made orthoses. results of conservative treatment are excellent if closed reduction and immobilisation were achieved.