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Roukoz B. Chamoun, William E. Whitehead, Daniel J. Curry, Thomas G. Luerssen and Andrew Jea

TG , Polley KA , Smith GF , Hardin WD Jr : Pediatric cervical spine injury: a three-year experience . J Trauma 41 : 310 – 314 , 1996 6 Gluf WM , Brockmeyer DL : Atlantoaxial transarticular screw fixation: a review of surgical indications, fusion rate, complications, and lessons learned in 67 pediatric patients . J Neurosurg Spine 2 : 164 – 169 , 2005 7 Goel A , Laheri V : Plate and screw fixation for atlanto-axial subluxation . Acta Neurochir (Wien) 129 : 47 – 53 , 1994 8 Gupta S , Goel A : Quantitative anatomy of the

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Steven W. Hwang, Loyola V. Gressot, Leonardo Rangel-Castilla, William E. Whitehead, Daniel J. Curry, Robert J. Bollo, Thomas G. Luerssen and Andrew Jea

C ervical spine arthrodesis is typically used in the pediatric population when a patient has instability related to congenital or traumatic pathology. The etiology of mechanical instability includes trauma, os odontoideum, infection, atlantoaxial rotatory subluxation, juvenile rheumatoid arthritis, Down syndrome, mucopolysaccharidoses, spondyloepiphyseal dysplasia, iatrogenic causes, tumors, and other less common entities. 13 , 20 , 27 , 28 , 32 , 36 , 55 , 69 , 80 Although it only accounts for 1%–4% of overall spinal trauma, pediatric spinal trauma is

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children with CSI were included in the study. For children <2 and 2–7, motor vehicle crash (MVC) was the most common cause of injury (55%, 37%). In children 8–15, sports accounted for as many injuries as MVC (23%, 23%). Children <2 and 2–7 were more commonly injured in the axial region (74%, 78%). In children age 2–7, atlanto-axial rotatory subluxation was the most common pattern (19.3%). In children 8–15, 53% of injuries were subaxial, while SCIWORA accounted for 16.1%. CSI frequently resulted in neurological deficit (axial 24%, subaxial 23%). The most devastating

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Loyola V. Gressot, Sudhakar Vadivelu, Steven W. Hwang, Daniel H. Fulkerson, Thomas G. Luerssen and Andrew Jea

/E Radiographs Associated Spine Abnormalities Neuro Deficit Management FU (mos) Outcome at Last FU present study 1 12, F fall from bed 5 0.9 3.0 stable none none 3 mos rigid collar, then Minerva 48 intact 2 14, F NAT 1 6.4 3.0 stable C-6 small syrinx none 3 mos Minerva 14 intact 3 10, M NAT 34 4.5 6.0 NR atlantoaxial rotatory subluxation, platybasia yes Minerva for 6 wks w/ progression, then O–C4 fusion 36 intact 4 4, F torticollis 8 → 10 † 5.5 → 7 † 3.8 → 10.8 † 14-mm

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Sandi K. Lam, Christina Sayama, Dominic A. Harris, Valentina Briceño, Thomas G. Luerssen and Andrew Jea

morphogenetic protein for salvage fusion in an infant with Down syndrome and craniovertebral instability. Case report . J Neurosurg 106 : 6 Suppl 480 – 483 , 2007 38 Meyer RA Jr , Gruber HE , Howard BA , Tabor OB Jr , Murakami T , Kwiatkowski TC , : Safety of recombinant human bone morphogenetic protein-2 after spinal laminectomy in the dog . Spine (Phila Pa 1976) 24 : 747 – 754 , 1999 39 Muscal E , Satyan KB , Jea A : Atlantoaxial subluxation as an early manifestation in an adolescent with undifferentiated spondyloarthritis: a case

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Loyola V. Gressot, Javier A. Mata, Thomas G. Luerssen and Andrew Jea

vertebral column malformations of the thoracolumbar spine have been grouped together using terms such as “congenital spondyloptosis,” “congenital vertebral dislocation,” “congenital dislocated spine,” “segmental spinal dysgenesis,” “medial spinal aplasia,” “congenital spinal stenosis,” “congenital duplication of the spinal canal,” “congenital kyphosis and subluxation of the thoracolumbar spine due to vertebral aplasia,” and “congenital lumbar kypholisthesis.” 3 , 5 , 8 , 10 , 12 , 16 , 20 , 21 , 23 , 25–29 It has been suggested that all of these terms describe a single

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Meng Huang, David D. Gonda, Valentina Briceño, Sandi K. Lam, Thomas G. Luerssen and Andrew Jea

70, M RA NA Extended 4.75 Yes Dysphagia 3 61, F RA Oc-C3 fusion Neutral 2.75 No Prolonged intubation 4 63, F Epidural tumor Oc-C4 fusion Flexed 6.7 Yes Dysphagia persisted 5 69, M RA NA NA 4.6 No Tracheostomy, dysphagia persisted 6 77, F RA, atlantoaxial subluxation Oc-C2 fusion Flexed (−18°) 4.9 Yes Dyspnea resolved after revision, dysphagia persisted 7 78, F Atlantoaxial osteoarthritis, occipitalization of C-1 Oc-C3 fusion Flexed (−14°) NA NA Dysphagia

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Christina Sayama, Caroline Hadley, Gina N. Monaco, Anish Sen, Alison Brayton, Valentina Briceño, Brandon H. Tran, Sheila L. Ryan, Thomas G. Luerssen, Daniel Fulkerson and Andrew Jea

Last FU Postop Orthosis 1 5 yrs, F Congenital CCJ instability Oc–C4 pst spinal fusion 5 2.8 Allograft cancellous bone chips, 30 cm 3 81 4 Y 2 10 yrs, M Traumatic C1–2 instability C1–2 pst spinal fusion 2 5.6 Allograft cancellous bone chips, 60 cm 3 13 4 N 3 16 yrs, M Congenital instability secondary to DS Oc–C5 pst spinal fusion 6 8 Allograft cancellous bone chips, 30 cm 3 28 4 N 4 9 yrs, F Traumatic C1–2 rotatory subluxation Oc–C2 pst spinal fusion 3 8 Allograft cancellous bone

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Christina Sayama, Matthew Willsey, Murali Chintagumpala, Alison Brayton, Valentina Briceño, Sheila L. Ryan, Thomas G. Luerssen, Steven W. Hwang and Andrew Jea

9–S1 PIF; L-2 resection of hemivertebra 24 Morselized cancellous allograft, local autograft 63 No None 8 2 yrs, 7 mos, M H/O VACTERL syndrome; congenital scoliosis T8–12 PIF; T-10 hemivertebral resection 4.2 Local autograft 63 No None 9 20 yrs, 0 mos, M H/O T11–12 discosteophyte; spinal cord compression; spastic paraparesis T11–12 discectomy; right T-12 transpedicular decompression; T11–L1 PIF 12 Local autograft 62 No DVT/PE postop 10 9 yrs, 11 mos, F Fixed C1–2 rotatory subluxation; BI Closed reduction