title: Management of a 3-year-old with an unstable C6-C7 diastasis without quadriplegia.
abstract: Caring for pediatric spine trauma patients places spine surgeons in situations that require unique solutions for complex problems. Recent case reports have highlighted a specific injury pattern to the lower cervical spine in very young children that is frequently associated with complete spinal cord injury.
  
  
  
  This report describes the presentation and treatment of a C6-C7 dislocation in a 3-year-old patient with an incomplete spinal cord injury. The highly unstable cervical injury and the need to prevent neurologic decline added complexity to the case.
  
  
  
  A multi-surgeon team allowed for ample manpower to position the patient; with individuals with the requisite training and experience to safely move a patient with a highly unstable cervical spine. Initial closed reduction under close neurophysiologic monitoring, posterior fusion and immediate anterior stabilization lead to a successful patient outcome with preserved neurologic function. A traumatic cerebrospinal fluid leak, while a concern early on during the procedure, resolved without direct dural repair and did not complicate the patient's fusion healing. Additional anterior stabilization and fusion allowed long-term stability with bone healing that may not be achievable with posterior fixation and/or soft tissue healing alone.
  
  
  
  Familiarity with the challenges and solutions presented in the case may be useful to surgeons who could face a similar challenge in the future.
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville School of Medicine, 550 South Jackson Street, 1st Floor ACB, Louisville, KY, 40202, USA.|Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.affiliation: Norton Neuroscience Institute, 210 East Gray Street Suite 1105, Louisville, KY, 40202, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Mutchnick
authors.affiliation: Norton Leatherman Spine Center, 210 East Gray Street, Suite 900, Louisville, KY, 40202, USA. leah.carreon@nortonhealthcare.org.
authors.forename: Leah Y
authors.initials: LY
authors.lastname: Carreon
mesh_terms: D000063:Accidents, Traffic; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D002675:Child, Preschool; D000070628:Closed Fracture Reduction; D000070631:Diastasis, Bone / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D017586:Diskectomy; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring; D055805:Moving and Lifting Patients; D013123:Spinal Fusion; D021801:Zygapophyseal Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*
keywords: Cervical spine diastasis; Cervical spine fusion; Closed reduction; Pediatric spine trauma; Surgical management