title: Circumferential cervical spine surgery in an 18-month-old female with traumatic disruption of the odontoid and C3 vertebrae. Case report and review of techniques. Case report and review of techniques.
abstract: METHODS
  A case study of an 18-month-old female with craniovertebral instability and spinal cord compression requiring circumferential stabilization. A review of surgical techniques in upper cervical spine and craniovertebral stabilization for young children is provided.
  
  
  OBJECTIVE
  To describe an interesting surgical approach in a young pediatric patient requiring circumferential stability at the craniovertebral junction.
  
  
  BACKGROUND
  Craniovertebral instability is problematic in the young pediatric population due to the inability to secure hardware for stabilization. We present an interesting case of spinal cord compression with craniovertebral instability in an 18-month-old female requiring circumferential cervical spine and craniovertebral stabilization.
  
  
  METHODS
  The patient presented with acute onset quadriparesis after a fall. Radiographs demonstrated C2-C3 disruption with canal compromise. Magnetic resonance imaging revealed signal changes of the spinal cord at C2-C3. Neurological examination revealed normal muscle volume with strength 1/5 in the upper extremities and 0/5 in the lower extremities. Respirations were normal with normal diaphragmatic function. Cranial nerves were intact.
  
  
  RESULTS
  Halo-traction attempted at 0.453 kg induced occipital-atlantal dislocation. The patient underwent anterior corpectomy of C3 and the base of C2 with autologous rib grafts placed from C2 to C4 and macropore as an anterior plating system. Posteriorly the patient had occiput-C3 fusion with a titanium rod and autologous rib grafts bilaterally. Postoperatively the patient regained normal neurological function with circumferential fusion after 4 months in a halo vest.
  
  
  CONCLUSIONS
  This case demonstrates the ability to achieve circumferential stabilization in the young pediatric patient. Injuries at the odontoid synchondrosis can be difficult to treat and are only complicated by having to achieve a posterior fusion at the craniovertebral junction. We present a successful case of circumferential fusion and offer a surgical technique to achieve spinal cord decompression and fusion of the upper cervical spine and craniovertebral junction in the young pediatric population.
authors.affiliation: Department of Neurosurgery, North Shore University Hospital, New Hyde Park, N.Y., USA. drrdd@yahoo.com
authors.forename: Rob D
authors.initials: RD
authors.lastname: Dickerman
authors.forename: Jonathan T
authors.initials: JT
authors.lastname: Morgan
authors.forename: Mark
authors.initials: M
authors.lastname: Mittler
mesh_terms: D000058:Accidental Falls; D001269:Atlanto-Occipital Joint / Q000473:pathology / Q000601:surgery; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D005260:Female; D050723:Fractures, Bone / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D007103:Immobilization / Q000295:instrumentation; D004204:Joint Dislocations / Q000175:diagnosis / Q000601:surgery; D007593:Joint Instability / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D009809:Odontoid Process / Q000293:injuries* / Q000601:surgery*; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000601:surgery*; D013123:Spinal Fusion