Artikel
Traumatic cervical spine instabilities in the young pediatric age group: Is routine instrumentation possible?
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Autoren
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F. Roser
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
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A. Badke
- Berufsgenossenschaftliche Unfallklinik Tübingen, Tübingen
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M. Schuhmann
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
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G. Maier
- Klinik für Neurochirurgie, Universitätsklinikum Tübingen, Tübingen
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Traumatic cervical instabilities in the paediatric age group frequently represent a challenge for the spine surgeon, as standard instrumentation techniques are not developed for the biomechanical needs in this patient group.
Methods: Since 2008, fourteen pediatric patients were treated in the Neurosurgical Department for traumatic cervical injury (age 9 month–15 years). Four of those treated by surgery were below the age of six.
Results: All patients suffered a high impact whiplash injury with either ligamentous rupture (N=5), bilateral condylar fractures with dislocation (N=5), atlanto-axial dislocation and instability (N=2) or C5 burst fractures (N=2). The ligamentous instabilities were all treated conservatively with a Halo-vest immobilization over 12 weeks. With no signs of instability in flexion/extension controls after 16 weeks and no treatment morbidity, the results were excellent. Burst fractures were treated with a 360° fusion (corpectomy with iliac crest/plate and dorsal fusion). Three patients below the age of six with severe craniocervical instability due to condylar disrupture, dural tear and brainstem contusion received routine screw and rod techniques with standard adult instrumentation material (3.5 mm screws; Neon™, UlrichMedical). In addition autologous bone grafts were used to enhance craniocervical fusion. A 9-month old patient was treated with an individualized rib-rod cranio-cervical fusion. All patients were placed into an additional Halo-Vest or Minerva Cast for 12 weeks. Follow-up studies showed excellent fusion in all patients and remarkable neurological recovery even years after trauma.
Conclusions: Excellent results can be achieved in severe paediatric cervical spine trauma with either conservative treatment for ligamentous instability or with surgical interventions in cases of craniocervical instabilities or burst fractures. Standard adult spine implants in young paediatric patients can be used even for patients up to 4 years or 16 kg weight.
