Fox Shandy, Allen Lauren, Norton Jonathan
Department of Surgery, University of Saskatchewan Royal University Hospital, 103 Hospital Drive, Saskatoon, SK S7N 0W6 Canada.
Spinal Cord Ser Cases. 2018 Jun 19;4:52. doi: 10.1038/s41394-018-0088-1. eCollection 2018.
Odontoid fractures in young children are rare. Most authors advocate for closed reduction and external stabilization as first line treatment. Unlike adults, young children are much less amenable to an awake reduction for real-time assessment of neurological function. We used spinal cord monitoring, as used in spine surgery, to assess the function of the spinal cord during the closed reduction in our 31-month-old patient.
A 31-month-old male presented with a displaced odontoid fracture and ASIA C spinal cord injury. Given his age, closed reduction and halo application were completed under general anesthesia guided by neuromonitoring. A less-than-ideal reduction initially was accepted due to a decline in motor-evoked potentials. Subsequently, there was no change in neurological status. The reduction was repeated under anesthesia, with monitoring, a number of times until good correction was achieved. Ultimately, a surgical fusion was required due to ligamentous instability. The child achieved a very good neurological outcome and a stable spine.
Neuromonitoring is an important adjunct to closed reductions when complete and reliable neurological assessment is not possible.
幼儿齿突骨折较为罕见。大多数作者主张将闭合复位及外固定作为一线治疗方法。与成人不同，幼儿很难配合清醒状态下的复位以实时评估神经功能。我们在一名31个月大的患儿进行闭合复位时，采用了脊柱手术中使用的脊髓监测来评估脊髓功能。
一名31个月大的男性患儿，出现齿突骨折移位及美国脊髓损伤协会（ASIA）C级脊髓损伤。鉴于其年龄，在神经监测引导下于全身麻醉下行闭合复位及头环固定。由于运动诱发电位下降，最初接受了不太理想的复位。随后，神经状态无变化。在麻醉及监测下多次重复复位，直至获得良好矫正。最终，由于韧带不稳定，需要进行手术融合。患儿获得了非常好的神经功能结果及稳定的脊柱。
当无法进行完整且可靠的神经评估时，神经监测是闭合复位的重要辅助手段。
