The Management Of Disorders Of The Child's Cervical Spine (hardcover)

Comprehensive yet practical, this book is the first of its kind to focus exclusively on both major and minor conditions affecting the pediatric cervical spine. Written by eminent orthopedic and spinal surgeons, it provides a systematic approach based on traditional categories: anatomy, pathology, imaging, and both surgical and non-surgical treatment strategies. Utilizing the most up-to-date evidence, the subject is approached in three main sections. The basic science of the pediatric cervical spine – anatomy, biomechanics, imaging and diagnostic techniques – is covered in part I. The clinical aspects of pediatric cervical spine disorders are discussed in part II, including trauma, inflammatory conditions, infections, tumors, congenital anomalies and others. The medical and surgical treatment of these disorders comprises part III, presenting conservative techniques such as immobilization and surgical techniques such as arthrodesis. Complications and other related pediatric cervical conditions are also covered in this last section. Written by an international panel of experts and skillfully edited by leaders in the field, __The Management of Children's Cervical Spine Disorders__ is a unique and definitive resource for pediatric orthopedic spine surgeons, neurologists and all medical professionals treating these delicate conditions. Dedication 5 Foreword 6 Preface 8 Introduction 15 Contents 10 Contributors 12 Part I: Basic Medical Science 16 1: Embryology and Anatomy of the Child’s Cervical Spine 17 Embryology and Definitions 17 Muscles of the Neck 21 Cervical Osteology 25 Ligamentous Support of the Child’s Cervical Spine 27 Summary 28 References 28 2: Biomechanics of the Growing Cervical Spine 29 Normal Cervical Spine Biomechanics 29 Functional Anatomy and Normal Biomechanics 29 Occiput to C2 29 Osseous Anatomy 29 Ligamentous Anatomy 30 Kinematics 30 Determinants of Stability 31 Subaxial Cervical Spine C3–C7 31 Osseous Anatomy 31 Ligamentous Anatomy 33 Kinematics 33 Determinants of Stability 33 Unique Biomechanical Characteristics of the Immature Cervical Spine 34 Growth 34 Structural Differences 35 Biomechanics of Cervical Spine Instrumentation 37 Occipitocervical Instrumentation 37 Summary 38 References 38 3: Pathology of the Child’s Cervical Spine and Its Clinical Implications 40 Connective Tissue Disorders 40 Marfan Syndrome 40 Introduction 40 Classification and Pathology 40 Demographics and Presentation 41 Diagnosis and Imaging 41 Treatment 41 Loeys-Dietz Syndrome 42 Introduction 42 Classification and Pathology 42 Demographics and Presentation 42 Diagnosis and Imaging 42 Treatment 42 Down Syndrome 43 Introduction 43 Demographics and Presentation 43 Diagnosis and Imaging 43 Treatment 43 Metabolic Conditions 44 Mucopolysaccharidoses 44 Introduction 44 Classification and Pathology 44 Demographics and Presentation 44 Diagnosis and Imaging 45 Treatment 45 Neurofibromatosis 46 Introduction 46 Classification and Pathology 46 Demographics and Presentation 46 Diagnosis and Imaging 46 Treatment 46 Skeletal Dysplasias 47 Introduction 47 Classification, Pathology, and Presentation 47 Diagnosis and Imaging 48 Summary 48 Infections and Inflammatory Conditions (See also Chapter 7 for the Clinical Discussion of these Conditions) 49 Juvenile Rheumatoid Arthritis 49 Introduction 49 Classification and Pathology 49 Demographics and Presentation 49 Diagnosis and Imaging 49 Treatment 50 Chronic Recurrent Multifocal Osteomyelitis 50 Introduction 50 Classification and Pathology 51 Demographics and Presentation 51 Diagnosis and Imaging 51 Treatment 52 Vertebral Osteomyelitis 52 Introduction 52 Classification and Pathology 52 Demographics and Presentation 53 Diagnosis and Imaging 53 Treatment 54 Intervertebral Disc Calcification 54 Introduction 54 Classification and Pathology 55 Demographics and Presentation 55 Diagnosis and Imaging 55 Treatment 55 Atlantoaxial Rotatory Subluxation 56 Introduction 56 Classification and Pathology 56 Demographics and Presentation 57 Diagnosis and Imaging 57 Treatment 58 Summary 58 References 59 4: Radiology of the Growing Cervical Spine 65 Introduction 65 Postnatal Development of the Pediatric Cervical Spine 65 C1 66 C2 67 C3–7 72 Normal Anatomical Variants Found in the Pediatric Cervical Spine 72 Pseudosubluxation 72 Pseudospread of the Atlas 73 Posteriorly Tilted Dens 74 Atlas-Dens Interval 75 Vertebral Body Wedging 75 Retropharyngeal Soft Tissue Anomalies 75 Absence of Lordosis 76 Secondary Ossification Centers 76 Assessing Images of the Pediatric Cervical Spine 76 Wackenheim Clivus Baseline 76 Atlanto-Dental Interval (ADI) 76 Basion-Dens Interval (BDI)/Basion- 76 Powers Ratio 77 Condylar Gap Method (Kaufman’s) 77 Pediatric Cervical Spine Injuries 78 Atlanto-Occipital Dislocation (AOD) 78 Atlas Fracture 79 Odontoid Process (Dens) Fracture 79 Hangman’s Fracture 80 Atlantoaxial Rotary Fixation 80 SCIWORA 81 Radiographic Assessment of Trauma 81 Summary 82 References 82 Part II: Clinical Aspects of Disorders of the Child’s Cervical Spine 84 5: Clinical Presentation and Physical Examination of Children with Cervical Spine Disorders 85 Introduction 85 Why the Immature Spine Is Different 85 Developmental Anatomy 85 History 87 Physical Examination 89 Imaging 91 Electrodiagnostic Studies 93 Summary 93 References 95 6: Pediatric and Adolescent Cervical Spine Trauma 97 Part I: Patient Evaluation 97 Introduction 97 Mechanism of Injury 98 Cervical Spine Characteristics: Child Versus Adult 98 Anatomical 98 Radiological 98 SCIWORA 99 Concomitant Injuries 100 Mortality 101 Spinal Cord Injury (SCI) 102 Emergency Management 102 Prehospital Care 102 Emergency Room Resuscitation 103 Patient Evaluation 103 History 103 Physical Exam 104 Radiological Evaluation 104 AP, Lateral, and Odontoid Views 104 Flexion-Extension Lateral Radiographs 105 Computed Tomography (CT) 105 Magnetic Resonance Imaging (MRI) 105 Clearing the Cervical Spine in Children 106 Difficulties with Pediatric Cervical Spine Protocols 106 Patient Stratification 106 Low-Risk Child 106 At-Risk Child 107 Imaging and Care Algorithm 108 Imaging 108 Care Plan 108 Positive Findings 108 Negative Findings in a Reliable Patient 108 Negative Findings in an Unreliable Patient 108 Part II: Pediatric Upper Cervical Spine Injuries 109 Cervical Vascular Injury 109 Occipital Condyle Fractures 109 Occipital Cervical Dislocation 109 Pediatric C1 Burst Fracture (Jefferson Fracture) 110 Pediatric Odontoid and Synchondrosis Fractures 111 Os Odontoideum 113 Pediatric C2 Spondylolisthesis (Hangman Fracture) 113 Traumatic Atlantoaxial Rotatory Subluxation (AARS) 115 Part III: Subaxial Cervical Spine Injuries in Children 116 Introduction 116 Demographics 117 Classification 117 Injury Patterns 118 Treatment 118 Posterior Element Fractures 118 Compression Fractures 120 Burst Fractures 120 Facet Dislocations 122 Spinal Cord Injury without Radiographic Abnormality (SCIWORA) 123 Spinal Cord Injury 125 Summary 125 References 125 7: Infections and Inflammatory Conditions of the Pediatric Cervical Spine 131 Introduction 131 Bacterial Infections of the Cervical Spine 131 Non-Tuberculous Discitis/Osteomyelitis 131 Clinical Presentation 132 Diagnostic Tests 132 Organisms 133 Treatment 133 Tuberculosis of the Cervical Spine 133 Clinical Presentation 134 Imaging 134 Treatment 134 Inflammatory Conditions of the Cervical Spine 134 Juvenile Idiopathic Arthritis 134 Evaluation 134 Treatment 135 Intervertebral Calcification of the Disc 136 Evaluation 136 Treatment 136 Grisel’s Syndrome 136 Evaluation 137 Treatment 138 Chronic Recurrent Multifocal Osteomyelitis (CRMO) 138 Evaluation 139 Treatment 139 Summary 139 References 140 8: Tumours of the Cervical Spine 142 Introduction 142 Clinical Examination and Preoperative Workup 143 History and Physical Examination 144 Imaging Studies 144 Histological Diagnosis: Biopsy 145 Oncological Staging and Treatment Principles 146 Complications 147 Benign Tumours 149 Osteoid Osteoma 149 Osteoblastoma 149 Osteochondroma 151 Haemangioma 152 Langerhans Cell Histiocytoses (LCH) 153 Aneurysmal Bone Cyst (ABC) 154 Giant Cell Tumour (GCT) 156 Miscellaneous Lesions 158 Malignant Tumours 158 Ewing Sarcoma (ES) 159 Osteosarcoma (OS) 161 Leukaemia and Haematological Malignancies 161 Metastasis in Cervical Spine and Miscellaneous Tumours 161 Summary 161 References 162 9: Congenital Disorders of the Child’s Cervical Spine 164 Introduction 164 Congenital Abnormalities of the Occipitocervical Joint 165 Ossification of C1 166 Occiput-C1 Fusion 166 Basilar Invagination 166 Atlantal Arch Defects 167 Os Odontoideum 168 Klippel-Feil Syndrome 169 Summary 173 References 173 10: Dysplasias in the Child’s Cervical Spine 177 Introduction 177 Skeletal Dysplasia Nomenclature and Classification 177 Atlantoaxial-Occipital Complex Abnormalities 180 Base of Skull Abnormalities 180 Cranio-Cervical Stenosis 180 Hydrocephalus 180 Platybasia 180 Basilar Invagination 180 Occipitalization of C1 and Pro-Atlas 181 Upper Cervical Spine Instability 181 Occiptocervical Instability 181 Atlantoaxial Instability 181 Radiological Signs of Upper Cervical Spine Instability 183 Surgical Options 185 Torticollis: Atlantoaxial Rotatory Fixation/Subluxation/Dislocation 186 Subaxial Cervical Spine Abnormalities 186 Abnormal Extradural Impingement 186 Kyphosis and Stenosis 186 Cervicothoracic Abnormalities 187 Summary 187 References 189 11: Congenital Muscular Torticollis 191 Introduction 191 Etiology and Epidemiology 191 Clinical Features and Associations 192 History and Physical Examination 193 Diagnosis and Imaging 193 Differential Diagnosis 194 Treatment 194 Other Entities of Congenital Torticollis 196 Summary 197 References 198 12: Cervical Spine Injuries in Athletes 199 Epidemiology 199 Developmental Anatomy (see also Chapter 1) 200 Radiographic Parameters 201 Mechanism of Injury 204 Types of Injury 205 Cervical Sprain and Strain 205 Stingers and Burners 205 Cervical Cord Neuropraxia and Transient Quadriplegia 206 Disc Disease/Herniation 207 Fractures and Fracture/Dislocation 207 Return to Play 208 Summary 212 References 212 Part III: The Medical and Surgical Treatment of Cervical Disorders in Children 216 13: Medical and Rehabilitative Techniques in Cervical Disorders of the Child 217 Congenital Torticollis 217 Acquired Torticollis 221 Soft Tissue Injury 222 Summary 223 References 223 14: Surgical Approaches to the Child’s Cervical Spine 225 Anterior Approach 225 Approaches to the Upper Cervical Spine (C1-C2) 225 Transoral Combined Mandible-­Splitting and Tongue-Splitting Approach 227 Anterior Retropharyngeal Approach 227 Lateral Retropharyngeal Approach 229 Sternal-Splitting Approach 231 Posterior Approach Cervical Spine 232 Positioning 234 Posterior Approach to the Craniocervical Junction 236 Subaxial Exposure 238 Summary 239 References 239 15: Spinal Cord Monitoring in Pediatric Cervical Spine Surgery 240 Introduction 240 Relative Importance of Sensory and Motor-Evoked Potential Monitoring and Electromyography 240 Definitions 241 Somatosensory-Evoked Potentials 241 Motor-Evoked Potentials 242 Alarm Criteria 242 Response Strategies to Alarm Criteria 243 Risks of Spinal Cord Monitoring 247 The Ideal Situation 247 Summary 248 References 248 16: External Immobilization of the Child’s Cervical Spine 249 Introduction 249 Anatomical and Biomechanical Considerations 249 Applications for Orthoses 256 Provision of External Support: Instability 256 Initial Trauma Management 257 Later Trauma Management 258 Postsurgical Treatment 258 Corrective Forces: Traction 258 Techniques 259 Collar Sizing 259 Halo Application in Children 259 Complications 260 Summary 261 References 261 17: Posterior Cervical Arthrodesis in Children 264 Introduction 264 Preoperative Considerations 264 Operative Considerations 265 C1 Screw Fixation 265 C2 Screw Fixation 267 C1-C2 Transarticular Screws 269 C1-C2 Cable Fixation 271 Complications 272 Subaxial Screw Fixation 273 Anatomy and CT Morphology 273 Technique 273 Clinical Studies 274 Cables and Wiring 275 Bone Graft 275 Summary 275 References 275 18: Anterior Cervical Arthrodesis in Children 278 Introduction 278 Indications for Anterior Cervical Arthrodesis in Children 278 Disc Herniation 279 Trauma 279 Cervical Spine Deformity 281 Tumor and Infection 281 Approach 282 Materials 282 Bone Grafting and Biologics 282 Instrumentation 284 Summary 286 References 286 19: Anterior Transoral Approaches to the Upper Cervical Spine in Children 288 Introduction 288 Anatomy 288 Preoperative Evaluation 289 Surgical Procedure 289 Airway Management 291 Postoperative Nutrition 291 Complications 291 Summary 292 References 292 20: Chiari Malformations and Foramen Magnum Stenosis 293 Introduction 293 Epidemiology 293 Signs and Symptoms of Chiari 1 294 Imaging Findings of Chiari 1 295 Surgical Planning in Chiari 1 296 Follow-Up 299 The Chiari Type II Malformation: Presentation, Diagnosis, and Surgical Management 299 Presentation and Pathophysiology 299 Diagnostic Findings 300 Surgical Management and Outcomes 301 Summary 302 References 302 21: Miscellaneous Conditions of the Head and Neck in Infants and Children 304 Introduction 304 Radiographic Studies 305 Benign and Malignant Neck Lesions 305 Benign Midline Neck Lesions 305 Benign Lateral Neck Lesions 305 Other Benign Neck Lesions 305 Malignant Neck Lesions 306 Thyroglossal Duct Cyst 306 Median Ectopic Thyroid and Lingual Thyroid 307 Dermoid and Epidermoid Cysts 307 Midline Cervical Cleft 308 Branchial Remnant Anomaly 308 Lymphadenopathy and Lymphadenitis 309 Lymphangioma 311 Cervical Teratoma 311 Torticollis (See also Chapter 11) 312 Hemangioma 314 Ectopic Cervical Thymus 316 Ranula 316 Parathyroid Gland 317 Salivary Gland Disorders 317 Lymphoma and Non-Hodgkin’s Lymphoma 318 Rhabdomyosarcoma 319 Neuroblastoma 320 Thyroid Neoplasms 320 Summary 321 References 321 22: Complication Types and Rates in Pediatric Cervical Spine Surgery 326 Introduction 326 Complications 326 Surgical Site Infection 327 Wound Dehiscence 327 CSF Leak 327 Vertebral Artery Injury 328 Iatrogenic Neurologic Complications 328 Implant-Related Complications 328 Pseudarthrosis 328 Postlaminectomy Kyphosis 329 Adjacent Segment Disease/Junctional Kyphosis/Fracture of Adjacent Vertebrae 331 Hyperostosis 331 Summary 332 References 332 Index 333 Front Matter ....Pages i-xvii Front Matter ....Pages 1-1 Embryology and Anatomy of the Child’s Cervical Spine (Jonathan H. Phillips)....Pages 3-14 Biomechanics of the Growing Cervical Spine (John Kemppainen, Burt Yaszay)....Pages 15-25 Pathology of the Child’s Cervical Spine and Its Clinical Implications (Ehsan Saadat, Daniel J. Hedequist, Patrick Wright)....Pages 27-51 Radiology of the Growing Cervical Spine (Paul D. Kiely, Gregory Cunn, Jonathan H. Phillips, Jahangir K. Asghar)....Pages 53-71 Front Matter ....Pages 73-73 Clinical Presentation and Physical Examination of Children with Cervical Spine Disorders (William C. Warner, Ilkka Helenius)....Pages 75-86 Pediatric and Adolescent Cervical Spine Trauma (Mitesh Shah, Martin J. Herman, Craig Eberson, John T. Anderson)....Pages 87-120 Infections and Inflammatory Conditions of the Pediatric Cervical Spine (Kaela Frizzell, Archana Malik, Martin J. Herman, Peter Pizzutillo)....Pages 121-131 Tumours of the Cervical Spine (Nanjundappa S. Harshavardhana, John P. Dormans)....Pages 133-154 Congenital Disorders of the Child’s Cervical Spine (Alejandro Dabaghi-Richerand, Robert N. Hensinger, Frances A. Farley)....Pages 155-167 Dysplasias in the Child’s Cervical Spine (Jennifer M. Bauer, William Mackenzie)....Pages 169-182 Congenital Muscular Torticollis (Kaela Frizzell, Archana Malik, Martin J. Herman, Peter Pizzutillo)....Pages 183-190 Cervical Spine Injuries in Athletes (Firoz Miyanji)....Pages 191-207 Front Matter ....Pages 209-209 Medical and Rehabilitative Techniques in Cervical Disorders of the Child (Katrina M. Lesher)....Pages 211-218 Surgical Approaches to the Child’s Cervical Spine (Haemish A. Crawford, William Warner)....Pages 219-233 Spinal Cord Monitoring in Pediatric Cervical Spine Surgery (Jonathan H. Phillips, Michael Isley)....Pages 235-243 External Immobilization of the Child’s Cervical Spine (Michael B. Johnson, Leah McLachlan)....Pages 245-259 Posterior Cervical Arthrodesis in Children (Daniel J. Hedequist, Anthony Stans)....Pages 261-274 Anterior Cervical Arthrodesis in Children (Emmanuel N. Menga, Michael C. Ain, Paul D. Sponseller)....Pages 275-284 Anterior Transoral Approaches to the Upper Cervical Spine in Children (Joshua Gottschall, James Kosko)....Pages 285-289 Chiari Malformations and Foramen Magnum Stenosis (Christopher A. Gegg, Greg Olavarria)....Pages 291-301 Miscellaneous Conditions of the Head and Neck in Infants and Children (David Miller)....Pages 303-324 Complication Types and Rates in Pediatric Cervical Spine Surgery (Urvij M. Modhia, Paul D. Sponseller)....Pages 325-331 Back Matter ....Pages 333-344