Montgomery Blake K, Orland Keith, Wilson Troy A, Chen William, Shirley Otis C, Segar Anand, Field Antony J, Crawford Haemish A
Orthopaedics, Starship Children's Hospital, Auckland, NZL.
Cureus. 2024 Jul 15;16(7):e64623. doi: 10.7759/cureus.64623. eCollection 2024 Jul.
Cervical spine injuries in pediatric patients can have devastating consequences if not properly diagnosed. The standard workup for suspected cervical spine injuries includes cervical X-rays and a high-resolution CT. If suspicion still exists then a cervical MRI is obtained. When the cervical MRI shows ligamentous edema but is unable to determine the integrity of the ligaments then additional workup is needed. Often a flexion and extension lateral cervical X-ray can help determine ligament integrity in the non-sedated cooperative age-appropriate patient. For pediatric patients who are unable to perform the flexion and extension X-ray, we perform a dynamic fluoroscopic examination of the cervical spine under anesthesia. The patient is positioned in the supine position. The C-arm is positioned in the lateral position. The surgeon manually performs distraction, flexion, extension, and translation maneuvers while obtaining live fluoroscopy and assessing for signs of cervical instability. If cervical instability exists then the appropriate definitive treatment can be performed. If the cervical spine is stable then cervical immobilization can be discontinued.
小儿患者的颈椎损伤若未得到正确诊断，可能会产生灾难性后果。疑似颈椎损伤的标准检查包括颈椎X线和高分辨率CT。若仍存在怀疑，则需进行颈椎MRI检查。当颈椎MRI显示韧带水肿但无法确定韧带完整性时，则需要进一步检查。对于非镇静状态下配合的适龄患者，通常颈椎屈伸侧位X线有助于确定韧带完整性。对于无法进行颈椎屈伸X线检查的小儿患者，我们在麻醉下对颈椎进行动态透视检查。患者取仰卧位。C形臂置于侧位。外科医生在进行实时透视并评估颈椎不稳定体征的同时，手动进行牵引、屈伸及平移操作。若存在颈椎不稳定，则可进行适当的确定性治疗。若颈椎稳定，则可停止颈椎固定。
