title: Instable cervical spine injury in a toddler: technical note.
abstract: OBJECTIVE
  Instable upper cervical spine injuries (CSI) in very young children are rare and consecutively only few data on the treatment and operative approaches exist in the literature. Hence, we suggest an operative strategy in the case of a 15-month-old infant treated for an instable CSI at the level of C2/3 at our department. Detailed steps of the operation with special consideration to the challenging anatomy of the immature spine are presented.
  
  
  METHODS
  A toddler suffered a CSI without neurological deficits after a stair fall. Computer tomography (CT) and magnetic resonance imaging (MRI) of the cervical spine revealed an instable luxation fracture of C2/3. As repositioning in the halo vest immobilization failed, surgical fusion was indicated.
  
  
  RESULTS
  Via a posterior midline approach, the lamina of C2 and C3 was conflated in a modified sublaminar wiring technique using non-resorbable sutures, sparing the ossification zones of the vertebral arches. Postoperative immobilization in a halo vest facilitated bony fusion of the laminae at C2/3 without lordotic displacement of the cervical spine.
  
  
  CONCLUSIONS
  We consider the instable CSI of the immature cervical in the very young a challenging situation for every treating physician. The particular features of the growing spine require special attention to avoid damage to the growth centers of the vertebrae. To our knowledge, this is the first technical report giving detailed information of an operative approach to the severely injured immature cervical spine and postoperative management.
authors.affiliation: Department of Neurosurgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany. oliver.mueller@uk-essen.de
authors.forename: Oliver M
authors.initials: OM
authors.lastname: Mueller
authors.forename: Thomas
authors.initials: T
authors.lastname: Gasser
authors.forename: Arnd
authors.initials: A
authors.lastname: Hellwig
authors.forename: Christian
authors.initials: C
authors.lastname: Dohna-Schwake
authors.forename: Ulrich
authors.initials: U
authors.lastname: Sure
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery; D004204:Joint Dislocations / Q000175:diagnosis* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D009460:Neurologic Examination; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D016103:Spinal Fractures / Q000175:diagnosis* / Q000601:surgery*; D013123:Spinal Fusion; D013537:Sutures; D014057:Tomography, X-Ray Computed