Severe spinal cord injury in craniocervical dislocation. Case-based update
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- 作者：Juan F. Martínez-Lage (1)
Fernando Alarcón (2)
Raul Alfaro (2)
Amparo Gilabert (3)
Susana B. Reyes (4)
María-José Almagro (1)
Antonio López López-Guerrero (1) - 关键词：Atlanto ; axial luxation ; Atlanto ; occipital distraction injuries ; Cervical spine fusion ; Cervical spine injuries ; Pediatric spinal cord injuries ; Post ; traumatic apnea ; Quadriplegia
- 刊名：Child's Nervous System
- 出版年：2013
- 出版时间：February 2013
- 年：2013
- 卷：29
- 期：2
- 页码：187-194
- 全文大小：430KB
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Fernando Alarcón (2)
Raul Alfaro (2)
Amparo Gilabert (3)
Susana B. Reyes (4)
María-José Almagro (1)
Antonio López López-Guerrero (1)
1. Unit of Pediatric Neurosurgery, Regional Service of Neurosurgery, Virgen de la Arrixaca University Children’s Hospital, 30120, El Palmar, Murcia, Spain
2. Unit of Spine Neurosurgery, Regional Service of Neurosurgery, Virgen de la Arrixaca University Hospital, 30120, El Palmar, Murcia, Spain
3. Section of Pediatric Radiology, Virgen de la Arrixaca University Children’s Hospital, 30120, El Palmar, Murcia, Spain
4. Pediatric Intensive Care Unit, Virgen de la Arrixaca University Children’s Hospital, 30120, El Palmar, Murcia, Spain - ISSN：1433-0350
文摘
Background Craniocervical distraction injuries, including atlanto-axial dislocation (AAD) and atlanto-ocipital dislocation (AOD), are often associated with severe spinal cord involvement with high morbidity and mortality rates. Many patients with these injuries die at the accident scene, but advances in emergency resuscitation and transport permit that many patients arrive alive to hospitals. Discussion Children with craniocervical distraction injuries usually present with a severe cranioencephalic traumatism that is the most relevant lesion at admission. After resuscitation and hemodynamic stabilization, the spinal cord damage appears as the main lesion. Apnea and quadriparesis, or quadriplegia, are usually present at the onset. Early diagnosis and management perhaps decrease life-threatening manifestations of the spinal lesion. But even so, the primary spinal cord insult is often irreversible and precludes obtaining a satisfactory functional outcome. Patients and methods We report the findings of four children with craniocervical distraction injuries (AOD and AAD) who presented with severe spinal cord damage. All patients were admitted with respiratory distress or apnea together with significant brain injuries. The medical records pertaining to these patients are summarized in regard to clinical features, management, and outcome. Conclusions In spite of timely and aggressive management, craniocervical injuries with spinal cord involvement continue to have a dismal prognosis. Outcome is closely related to the severity of the initial brain and spinal cord damage and is nearly always fatal in cases of complete spinal cord transection. Priority should be given to life-threatening complications. Ethic issues on indications for surgery deserve a detailed discussion with the children’s parents.