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TREATMENT OF C1-C2 INJURIES IN VERY YOUNG
CHILDREN M. Balsano, A.Villaminar, M.Comisso
ORTHOPEDIC AND SPINE DEPARTMENT THIENE,
VICENZA, ITALY
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PURPOSE AND METHODS

• Cervical spine injuries in the very young child
  are relatively uncommon
• The increased soft tissue elasticity and anatomic
  differences in children younger than 8 years make
  upper cervical spine injuries more likely
• We have collected 3 cases (2 females and 1 male)
  of C1-C2 injuries in our department, all of them
  following a car crash
• The patients had respectively 2, 2.5 and 3 yrs.
  at the admission in hospital

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PURPOSE AND METHODS

• 2 lesions had been classified as unstable and
  treated with posterior surgical ostheosynthesis ,
  using a posterior surgical approach with a
  reabsorble wire passing under the laminae of C1
  and C2 and fused with autologous bone grafts
  halo-vest is then had been placed for achieve the
  best external immobilization
• 1 patient classified as stable and treated with
  halo-vest

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Female, 2 yrs. C1-C2 INJURY
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FIRST TREATMENT
HALO-VEST POSITIONING
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POSTERIOR STABILIZATION WITH HIGH TENSION
RESISTANCE THREAD ..
PERCUTANEUS ILIAC BONE GRAFT
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Intraoperative x-ray after open reduction
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2 yrs. post.op. (complete fusion C1-C2-C3)
3 months post.op.
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CONCLUSIONS

• In cervical spine injuries in children there is
  insufficient evidence to support treatment
  standards
• C1-C2 injury can cause a ligamentous instability
  and associated deformity
• Posterior stabilization and halo vest
  immobilization seems to be effective to stabilize
  the lesion and to achieve the best cervical
  alignment

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REFERENCES
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Georgopoulos G., Pizzutillo P. D., Lee M. S.
Occipito-Atlantal Instability in
Children. J.B.J.S March 1987 Vol 69-A No
3429-436. Henris P., Dennis Lyne E., Lifton C.,
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Injuries in Children. Clin.Orthop. Nov/Dec, 1977
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Critical Care March 1996 40(3)408-411,
Management of Pediatric Cervical Spine and
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March 2002. Matsumoto M. et al. Traumatic
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