A case report on a child with fracture and dislocation of the upper cervical spine accompanied by spinal cord injury

Medicine, 2022 · DOI: http://dx.doi.org/10.1097/MD.0000000000029717 · Published: July 29, 2022

Simple Explanation

This case report describes an 8-year-old boy who experienced a C2 fracture and dislocation along with a spinal cord injury following a car accident. The boy's condition was complicated by a left C2–C3 articular process interlocking, which made closed reduction methods unsuccessful. The patient underwent open reduction and internal fixation using a posterior cervical approach, which led to satisfactory outcomes, including improved spinal alignment and neurological function.

Study Duration

8-month follow-up

Participants

One 8-year-old boy

Evidence Level

Level 4, Case Report

Key Findings

1
Posterior open reduction with pedicle screw and lateral mass screw internal fixation can achieve satisfactory results in treating cervical fracture and dislocation with unilateral facet lock.
2
An accurate diagnosis and careful treatment strategy are essential for managing complex cervical spine injuries in children.
3
The boy was discharged from the hospital 1 month after surgery and showed significant improvement in clinical symptoms, with radiological examination confirming satisfactory reduction and spinal cord decompression at the 8-month follow-up.

Research Summary

This study reports a case of an 8-year-old boy with a C2 fracture and dislocation accompanied by spinal cord injury (SCI) and left C2–C3 facet locking, who underwent open reduction and internal fixation. The surgical intervention involved a posterior cervical approach with pedicle screw and lateral mass screw internal fixation after conservative treatment (cranial traction) failed. The patient demonstrated significant recovery, including improved muscle strength, regained lower limb and urination/defecation functions, and satisfactory spinal alignment observed in follow-up imaging.

Practical Implications

Surgical Management of Complex Pediatric CSI

The case suggests that posterior open reduction and internal fixation are viable options for complex cervical spine injuries in children, particularly when closed reduction methods are unsuccessful.

Importance of Early and Accurate Diagnosis

Highlights the need for accurate diagnosis and appropriate treatment strategies to manage complex cervical spine injuries in children effectively.

Potential for Neurological Recovery

Demonstrates the potential for significant neurological recovery in children with spinal cord injuries following surgical intervention and rehabilitation.

Study Limitations

1
Single case report limits generalizability.
2
Short follow-up period (8 months) to assess long-term outcomes.
3
The effect of the posterior pedicle screws on the development of the upper cervical spine needs further long-term follow-up.

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