Internal stabilization of a flexion-distraction injury of the upper cervical spine of a toddler: A new technique and literature review

Study Design.: A case report and literature review. Objective.: To present a new and simple technique of fixation without fusion of a rare unstable Salter-Harris type I injury in the upper cervical spine of a 23-month-old toddler. Summary of Background Data.: Surgical treatment of unstable pediatric cervical spine injuries most commonly involves posterior fusion with internal fixation, usually posterior wiring. Methods.: Detailed description of the surgical procedure carried out for fixating an unstable flexion-distraction injury in a 23-month-old toddler, with severe head injury and pneumothorax, is presented. Results.: A rare unstable flexion-distraction injury in the upper cervical spine of a toddler was successfully treated with a posterior Number 2 Vicryl (polyglactin 910; ETHICON Division of Johnson & Johnson) suture fixation, with good healing of the ligaments and end plates, without fusion. Preservation of motion was achieved without obvious instability at 28 months postsurgery. Conclusion.: In selected cases of cervical spine injuries in the young pediatric population, simple stabilization of the spine using degradable Number 2 Vicryl (polyglactin 910) sutures with minimal exposure can provide sufficient stability until healing occurs. Advantages are that fusion is avoided and motion preserved.