title: Highly unstable cervical spine injury in an infant: a case report.
abstract: Although the rate of surgical intervention for pediatric cervical spine injuries has risen, none of these instrumentation techniques has been reported in children less than 1 year of age. Additional consideration with placement of wires or cables is not safe because of the presence of cartilaginous bone and poor bone strength. The authors report a technique of internal fixation without fusion using nonabsorbable synthetic suture in an infant with unstable cervical injury.
  
  
  METHODS
  A 5-month-old girl was transported to emergency department and computed tomography showed severe distraction injury at the C6-7 level with total disruption of the facet joints bilaterally. To improve her general condition, she was placed in a customized occipito-cervical brace until surgical stabilization could be performed. After 1 month, surgical fixation was performed. After removing all soft tissues at the appropriate level, a hole was made in the center of the superior articular process of C6. A nonabsorbable suture (2-0 Ethibond; Ethicon, Somerville, NJ, USA) was passed from the superior articular process to the facet joint. The suture was passed into the spinous process of the lower level, and it was progressively tightened and radiographs were taken until anatomic reduction was achieved.
  
  
  RESULTS
  After surgery, solid fusion was achieved. She was able to sit up in a stroller after 6 months.
  
  
  CONCLUSIONS
  As surgical treatment of pediatric cervical spine injuries is unsuitable for infants, the Ethibond sutures are strong enough to hold and stabilize the spine. This suturing technique can be used as an alternative treatment for cervical injury in infants.
authors.affiliation: Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
authors.forename: Sue young
authors.initials: Sy
authors.lastname: Ha
authors.forename: Sun-Ho
authors.initials: SH
authors.lastname: Lee
authors.forename: Eun-Sang
authors.initials: ES
authors.lastname: Kim
authors.forename: Hyung Jin
authors.initials: HJ
authors.lastname: Shin
authors.forename: Whan
authors.initials: W
authors.lastname: Eoh
mesh_terms: D000063:Accidents, Traffic; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D016103:Spinal Fractures / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*