Transpharyngeal closed reduction displacement of the first cervical vertebra in children

Abstract

BACKGROUND: Currently, the treatment of children with atlantoaxial rotational block has no standard protocol. The proposed conservative methods are difficult and require long-term hospitalization, whereas surgical treatment is associated with a risk of complications.

AIM: This study aimed to develop and evaluate the effectiveness of the transpharyngeal closed reduction method for first cervical vertebral displacement in children.

MATERIALS AND METHODS: The study presents the analysis results of clinical cases of 46 children with atlantoaxial rotational fixation with types I–II subluxations by Fielding and Hawkins the CI transpharyngeal closed reduction method. The average age of the patients was 4.5 ± 2.6 years. The time of admission of patients after the disease onset varied from 1 to 30 days. The reduction technique consisted of the following elements: 1. A bracket is installed for traction behind the skull along the axis; 2. The surgeon pulls the bracket along the axis, while using the index finger of the other hand in the oropharynx fixes the anterior arch of the atlas, creating a fulcrum; 3. Rotational displacement of the atlas is eliminated by rotational movements with simultaneous traction along the axis; and 4. The anatomical position of the atlas and axis is controlled by an X-ray image intensifier.

RESULTS: Only in one case of recurrent dislocation was noted after 4 days. The efficiency of primary reduction was 97.8%. Pain syndrome on the visual analog scale was reduced by 62.3%. Neurological deficit recurrence was not noted. The average bed-day was 2.5 ± 1.3 days.

CONCLUSION: Transpharyngeal closed reduction method for first cervical vertebral displacement in children of the younger age group is effective for atlantoaxial rotational fixation treatment in early admitted patients, which determines the prospects for its wider application in the practice of specialized hospitals.

Keywords

injury of the cervical spine / atlantoaxial rotational fixation / closed reduction / transpharyngeal access / children

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Wan Z., Minasov T.B., Yakupova E.R., Ginoyan A.O., Saubanov R.A.