Gressot Loyola V, Vadivelu Sudhakar, Hwang Steven W, Fulkerson Daniel H, Luerssen Thomas G, Jea Andrew
Division of Pediatric Neurosurgery, Texas Children's Hospital, and Department of Neurosurgery, Baylor College of Medicine, Houston, Texas;
J Neurosurg Pediatr. 2014 Feb;13(2):196-203. doi: 10.3171/2013.11.PEDS13422. Epub 2013 Dec 20.
Cervical spondylolysis is a rare condition that results from a pars interarticularis defect. The C-6 level is the most frequently involved site in the cervical spine. Its clinical presentations range from incidental radiographic findings to neck pain and, rarely, neurological deficits. Although 150 patients with subaxial cervical spondylolysis have been reported, a mere 24 adult and pediatric patients with C-2 spondylolysis have been described. The long-term outcomes of very young children with bilateral C-2 spondylolysis are of great interest, yet only a few longitudinal studies exist.
The authors retrospectively reviewed 5 cases of bilateral C-2 spondylolysis at Texas Children's Hospital and Riley Children's Hospital; these were combined with 5 other cases in the literature, yielding a total of 10 patients. Data regarding the patients' age, sex, C2-3 angulation and displacement, associated spine anomalies, neurological deficits, treatment, and most recent follow-up were recorded.
The patients' ages ranged from 3 to 36 months (mean 12.9 months). There were 6 boys and 4 girls. The C2-3 angulation, displacement, and width of pars defect were measured when available. The mean C2-3 angulation was 9.5° (range 1-34°), the mean C2-3 displacement was 4.78 mm (range 1.1-10.8 mm), and the mean width of the pars defect was 4.16 mm (range 0.9-7 mm). One patient developed myelopathy and spinal cord injury. All 10 of the patients were treated initially with conservative therapy: 3 with close observation alone, 1 with a rigid cervical collar, 4 with a Minerva jacket, 1 with a sternal-occipital-mandibular immobilizer, and 1 with a halo vest. Three patients ultimately underwent surgery for internal fixation due to progressive instability or development of neurological symptoms. All patients were neurologically intact at the last follow-up (mean 44.3 months, range 14-120 months).
Based on the literature and the authors' own experience, they conclude that most very young children with C-2 spondylolysis remain neurologically intact and maintain stability in long-term follow-up despite the bony defect. This defect is often an asymptomatic incidental finding and may be managed conservatively. More aggressive therapy including surgery is indicated for those patients with a neurological deficit from spinal cord compromise secondary to stenosis and local C-2 kyphosis, progressive deformity, or worsening C2-3 instability.
颈椎峡部裂是一种由关节突间部缺损导致的罕见病症。C6节段是颈椎最常受累的部位。其临床表现从偶然的影像学发现到颈部疼痛，很少出现神经功能缺损。虽然已有150例下颈椎峡部裂患者的报道，但仅有24例成人和儿童C2峡部裂患者被描述。双侧C2峡部裂的幼儿的长期预后备受关注，但仅有少数纵向研究。
作者回顾性分析了德克萨斯儿童医院和莱利儿童医院的5例双侧C2峡部裂病例；并与文献中的其他5例病例相结合，共10例患者。记录了患者的年龄、性别、C2-3成角和移位情况、相关脊柱异常、神经功能缺损、治疗方法以及最近的随访情况。
患者年龄从3个月至36个月不等（平均12.9个月）。其中男孩6例，女孩4例。如有数据，测量C2-3成角、移位和峡部缺损宽度。平均C2-3成角为9.5°（范围1-34°），平均C2-3移位为4.78mm（范围1.1-10.8mm），峡部缺损平均宽度为4.16mm（范围0.9-7mm）。1例患者出现脊髓病和脊髓损伤。所有10例患者最初均接受保守治疗：3例仅密切观察，1例使用硬质颈托，4例使用密涅瓦支具，1例使用胸骨-枕-下颌固定器，1例使用头环背心。3例患者因病情进展不稳定或出现神经症状最终接受手术内固定。所有患者在最后一次随访时神经功能均完整（平均44.3个月，范围14-120个月）。
基于文献和作者自身经验，他们得出结论，大多数双侧C2峡部裂的幼儿在长期随访中神经功能保持完整，尽管存在骨质缺损，但仍能维持稳定性。这种缺损通常是无症状的偶然发现，可采用保守治疗。对于因狭窄和局部C2后凸继发脊髓受压导致神经功能缺损、进行性畸形或C2-3不稳定加重的患者，需采取更积极的治疗措施，包括手术治疗。
