Transpharyngeal closed reduction displacement of the first cervical vertebra in children

Cover Page

Cite item

Full Text

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.

About the authors

Zongmiao Wan

First Affiliate Hospital of Nanchang University

Email: zongmiao2008@163.com
ORCID iD: 0000-0002-0641-6619

PhD, MD, Professor

Taiwan, Province of China, Nanchang

Timur B. Minasov

Bashkir State Medical University

Email: m004@yandex.ru
ORCID iD: 0000-0003-1916-3830
SPIN-code: 7865-6011

Dr. Sci. (Med.), Professor

Russian Federation, 3, Lenina st., Ufa, 450008, Republic of Bashkortostan

Ekaterina R. Yakupova

Bashkir State Medical University

Email: katya.yakupova1@yandex.ru
ORCID iD: 0000-0002-5496-0766
SPIN-code: 1617-3278

Postgraduate Student

Russian Federation, 3, Lenina st., Ufa, 450008, Republic of Bashkortostan

Akop O. Ginoyan

Bashkir State Medical University

Email: akop87@yandex.com
ORCID iD: 0000-0001-7461-4417
SPIN-code: 8955-4458

Assistant of the Department of Traumatology

Russian Federation, 3, Lenina st., Ufa, 450008, Republic of Bashkortostan

Radmir A. Saubanov

Bashkir State Medical University

Author for correspondence.
Email: saubanov.radmir@yandex.ru
ORCID iD: 0000-0002-8974-6188
SPIN-code: 9848-9081

Assistant of the Department of Traumatology

Russian Federation, 3, Lenina st., Ufa, 450008, Republic of Bashkortostan

References

  1. Gubin AV. Ostraya krivosheya u detei : Posobie dlya vrachei. Saint Petersburg: N-L, 2010. 72 p. (In Russ.)
  2. Goel A. Torticollis and rotatory atlantoaxial dislocation: A clinical review. J Craniovertebr Junction Spine. 2019;10(2):77–87. doi: 10.4103/jcvjs.JCVJS_40_19
  3. Götze M, Hagmann S. Torticollis in children. Orthopade. 2019;48:503–507. (In German). doi: 10.1007/s00132-019-03740-7
  4. Gubin AV, Ulrikh EV, Yalfimov AN, Taschilkin AI. C1–C2 subluxation — myth or reality of acute torticollis in children? Spine Surgery. 2008;(4):8–12. (In Russ.) doi: 10.14531/ss2008.4.8-12
  5. Sobolewski BA, Mittiga MR, Reed JL. Atlantoaxial rotary subluxation after minor trauma. Pediatr Emerg Care. 2008;24(12):852–856. doi: 10.1097/PEC.0b013e31818ea0d3
  6. Powell EC, Leonard JR, Olsen CS, et al. Atlantoaxial Rotatory Subluxation in Children. Pediatr Emerg Care. 2017;33(2):86–91. doi: 10.1097/PEC.0000000000001023
  7. James G, Thompson DNP. Atlanto-axial rotatory fixation: a serious potential complication of paediatric ENT surgery that requires prompt diagnosis and treatment. J Laryngol Otol. 2017;131(11):940–945. doi: 10.1017/S0022215117001918
  8. Sakaida H, Akeda K, Sudo A, Takeuchi K. Atlantoaxial rotatory fixation as a rare complication from head positioning in otologic surgery: Report of two cases in young children. Patient Saf Surg. 2017;11:5. doi: 10.1186/s13037-016-0116-7
  9. Hill CS, Borg A, Tahir MZ, Thompson DNP. Atlantoaxial rotatory fixation in childhood: a staged management strategy incorporating manipulation under anaesthesia. Childs Nerv Syst. 2021;37(1):167–175. doi: 10.1007/s00381-020-04727-y
  10. Gubin AV, Ulrikh EV, Mushkin AYu, et al. Emergency vertebrology: cervical spine in children. Spine Surgery. 2013;(3):81–91. (In Russ.) doi: 10.14531/ss2013.3.81-91
  11. Sundseth J, Berg-Johnsen J, Skaar-Holme S, et al. Atlantoaxial rotatory fixation — a cause of torticollis. Tidsskr Nor Laegeforen. 2013;133:519–523. (In Norwegian) doi: 10.4045/tidsskr.11.1540
  12. Garkavenko YE, Pozdeev AP, Kriukova IA. Algorithm for torticollis diagnosis in children of younger age groups. Pediatric Traumatology, Orthopaedics and Reconstructive Surgery. 2021;9(4):477–490. (In Russ.) doi: 10.17816/PTORS79988
  13. Ross DzhDzh, Mur K. Atlanto-aksial’nyi rotatsionnyi podvyvikh. P. 268–273. In: Luchevaya diagnostika. Pozvonochnik. Moscow: Izdatel’stvo Panfilova, 2018. 1184 p. (In Russ.)
  14. Watanabe K, Hirano T, Katsumi K, et al. Radiographic Outcomes of Upper Cervical Fusion for Pediatric Patients Younger Than 10 Years. Spine Surg Relat Res. 2017;1(1):14–19. doi: 10.22603/ssrr.1.2016-0013
  15. Slaar A, Fockens MM, Wang J, et al. Triage tools for detecting cervical spine injury in pediatric trauma patients. Cochrane Database Syst Rev. 2017;12(12):CD011686. doi: 10.1002/14651858.CD011686.pub2
  16. Hannonen J, Perhomaa M, Salokorpi N, et al. Interventional magnetic resonance imaging as a diagnostic and therapeutic method in treating acute pediatric atlantoaxial rotatory subluxation. Exp Ther Med. 2019;18(1):18–24. doi: 10.3892/etm.2019.7565
  17. Fielding JW, Hawkins RJ. Atlanto-axial rotatory fixation. (Fixed rotatory subluxation of the atlanto-axial joint). J Bone Joint Surg Am. 1977;59(1):37–44. doi: 10.2106/00004623-197759010-00005
  18. Isidro S, Molinari R, Ikpeze T, et al. Outcomes of halo immobilization for cervical spine fractures. Global Spine J. 2019;9(5):521–526. doi: 10.1177/2192568218808293
  19. Gubin AV, Burtsev AV, Ryabykh SO, et al. Surgical treatment of children with non-traumatic old atlanto-axial rotatory fixation. Traumatology and orthopedics of Russia. 2015;21(4):87–94. (In Russ.) doi: 10.21823/2311-2905-2015-0-4-87-94
  20. Berghmans JM, Poley MJ, van der Ende J, et al. A Visual Analog Scale to assess anxiety in children during anesthesia induction (VAS-I): Results supporting its validity in a sample of day care surgery patients. Paediatr Anaesth. 2017;27(9):955–961. doi: 10.1111/pan.13206
  21. Abel TJ, Yan H, Canty M, et al. Traumatic atlanto-occipital dislocation in children: is external immobilization an option? Childs Nerv Syst. 2021;37:177–183. doi: 10.1007/s00381-020-04680-w
  22. Baindurashvili AG, Ivanova NE, Kobyzev AE, Kononova EL. Symptom complex of chronical atlantoaxial subluxation in paediatric patients. Traumatology and orthopedics of Russia. 2012;(1):85–88. (In Russ.) doi: 10.21823/2311-2905-2012-0-1-98-107
  23. Wang C, Yan M, Zhou HT, et al. Open reduction of irreducible atlantoaxial dislocation by transoral anterior atlantoaxial release and posterior internal fixation. Spine. 2006;31(11):E306–313. doi: 10.1097/01.brs.0000217686.80327.e4
  24. Wang S, Yan M, Passias PG, Wang C. Atlantoaxial Rotatory Fixed Dislocation: Report on a Series of 32 Pediatric Cases. Spine. 2016;41(12):E725–E732. doi: 10.1097/BRS.0000000000001414
  25. Sanborn MR, DiLuna ML, Whitmore RG, Storm PB. Fluoroscopically guided, transoral, closed reduction, and halo vest immobilization for an atypical C-1 fracture. J Neurosurg Pediatr. 2011;7(4):380–382. doi: 10.3171/2011.1.PEDS10384
  26. Alqroom RY, Jeszenszky DJ, Michalitsis GS, Franke J. Non-traumatic Atlanto-axial Rotatory Subluxation-Grisel’s Syndrome Case Report and Literature Review. J Spine. 2016;5:312. doi: 10.4172/2165-7939.1000312
  27. Jeszenszky D, Fekete T, Kleinstück F, et al. Transoral Closed Reduction of Fixed Atlanto-Axial Rotatory-Subluxation (AARS) in Childhood and Adolescence. Clin Spine Surg. 2018;31(5):E252–E256. doi: 10.1097/BSD.0000000000000563

Supplementary files

Supplementary Files
Action
1. JATS XML
Download
2. Fig. 1. Traditional conservative treatment using the halo apparatus and external immobilization

Download (209KB)
Indexing metadata
3. Fig. 2. Topographic relationships of the oropharynx and atlantoaxial articulation

Download (88KB)
Indexing metadata
4. Fig. 3. Stages of transpharyngeal closed reduction of C1 dislocation: a — traction and rotational movements from the outside and fixation of the arch of the atlas with the index finger through the mouth; b — lateral X-ray of the cervical spine with a schematic figure of the inserted finger; c — lateral X-ray of the cervical spine before repositioning — C1 rotational subluxation; d — lateral X-ray after reduction — a normal ratio of the atlantoaxial joint

Download (202KB)
Indexing metadata
5. Fig. 4. The appearance of the child (a, b) and three-dimensional reconstruction of the cervical spine (c)

Download (122KB)
Indexing metadata
6. Fig. 5. Reduction of C1 subluxation and X-ray control: a — transpharyngeal reduction of C1 subluxation; b — X-ray before reduction; c — X-ray after reduction; d — X-ray after reduction, lateral view

Download (129KB)
Indexing metadata
7. Fig. 6. X-ray data at the admission of a 9-year-old boy: a — sagittal plane; b — axial plane; c — 3D reconstruction

Download (93KB)
Indexing metadata
8. Fig. 7. Transpharyngeal reduction (a), lateral X-ray before reduction (b), after reduction (c), the result of the osteosynthesis (d) and lateral X-ray (e)

Download (176KB)
Indexing metadata

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies