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Mohammed A. Eleraky, Nicholas Theodore, Mark Adams, Harold L. Rekate and Volker K. H. Sonntag

in children with complete SCIs and five in those with incomplete SCIs. In patients with lower cervical spine injuries, the mortality rate was 10%, whereas it was 20% in patients with upper cervical spine injuries. Five patients with complete upper SCIs died in the hospital within the first 72 hours of injury, and six died 1 to 3 years after injury of causes unrelated to injury. Two patients with incomplete SCIs died within the first 24 hours after sustaining multiple traumatic injuries. One patient with an incomplete SCI died of a concomitant severe head injury 2

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Seref Dogan, Sam Safavi-Abbasi, Nicholas Theodore, Eric Horn, Harold L. Rekate and Volker K. H. Sonntag


In this study the authors evaluated the mechanisms and patterns of injury and the factors affecting management and outcome of pediatric subaxial cervical spine injuries (C3–7).


Fifty-one pediatric patients (38 boys and 13 girls; mean age 12.4 years, range 10 months–16 years) with subaxial cervical spine injuries were reviewed retrospectively. Motor vehicle accidents (MVAs) were the most common cause of injury. Overall, 12% presented with a dislocation, 63% with a fracture, 19% with a fracture–dislocation, and 6% with a ligamentous injury. The most frequently injured level was C6–7 (33%); C3–4 (6%) was least frequently involved. Sixty-four percent of patients were neurologically intact, 16% had incomplete spinal cord injuries (SCIs), 14% had complete SCIs, and three patients (6%) died after admission and before assessment. Treatment was conservative in 64%: seven (13%) wore a halo vest and 26 (51%) wore a rigid cervical orthosis. Surgery was performed in the other 18 patients (36%), with the breakdown as follows: 15 (30%) underwent an anterior approach, two (4%) had posterior approaches, and one (2%) had a combined approach. Postoperatively, four patients (8%) who had a neurological deficit improved. The overall mortality rate was 8%; all deaths were related to MVAs. There were no surgery-related deaths or complications.


Subaxial cervical spine injuries are common in children 9 to 16 years of age, and occur principally between C-5 and C-7. Multilevel injury is more common in children 8 years of age and older than in younger children and infants. Most patients with subaxial cervical spine injuries can be treated conservatively. Both anterior and posterior approaches are safe and effective.

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Eric M. Horn, Nicholas Theodore, Iman Feiz-Erfan, Gregory P. Lekovic, Curtis A. Dickman and Volker K. H. Sonntag

respiratory or cardiac failure (periprocedural mortality rate 14.3%). One of these patients had a living will that dictated that no aggressive treatments should be undertaken and died in the hospital after respiratory distress developed; the other patients died in nursing homes. Three of the six patients who died unexpectedly had sustained an acute traumatic injury that led to cervical instability. None of these three patients, however, had neurological deficits or other significant traumatic injuries other than cervical fractures. The other three patients had either remote

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Eric M. Horn, Iman Feiz-Erfan, Gregory P. Lekovic, Curtis A. Dickman, Volker K. H. Sonntag and Nicholas Theodore

in all patients because multiple traumatic injuries were present. Likewise, the severity of SCI could not always be assessed accurately due to brainstem dysfunction and concomitant TBI. The mortality rate was highest in patients presenting with a TBI. Although the mortality rate was lower in patients presenting with SCI, the rate of persistent neurological deficit was higher in this group during the follow-up period. TABLE 2 Distribution of neurological status at presentation and outcome * Deficits at Presentation No. of Cases Mean Age

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Seref Dogan, Sam Safavi-Abbasi, Nicholas Theodore, Steven W. Chang, Eric M. Horn, Nittin R. Mariwalla, Harold L. Rekate and Volker K. H. Sonntag

injury and underwent surgery had good alignment without significant deformity. Moller et al. 33 reported predominantly favorable long-term outcomes in 23 patients with thoracic and lumbar vertebral fractures and no or minor neurological deficits. Our study confirms the low mortality rate associated with pediatric thoracolumbar injuries. 24 , 39 Our findings highlight that the prognosis of pediatric patients with cervical spine injury depends on whether neurological injury is also present. All neurologically intact patients remained so during follow up. Of our

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Sam Safavi-Abbasi, Joseph M. Zabramski, Pushpa Deshmukh, Cassius V. Reis, Nicholas C. Bambakidis, Nicholas Theodore, Neil R. Crawford, Robert F. Spetzler and Mark C. Preul

instrumentation, lesions of the posterior fossa and petroclival region can now be treated surgically with acceptable morbidity and mortality rates. 1–5 , 9 , 10 , 17 , 19–21 , 23 , 32 , 34 , 35 , 37 , 40 , 46 , 47 An improved understanding of the radiosurgical management of these lesions has also contributed to their cure. The development of skull base approaches, including the introduction of contemporary transpetrosal approaches and their combinations, has created many options for achieving wide surgical exposure of the petroclival region 1–4 , 9 , 10 , 17 , 19–21 , 34

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Ali A. Baaj, Juan S. Uribe, Tann A. Nichols, Nicholas Theodore, Neil R. Crawford, Volker K. H. Sonntag and Fernando L. Vale

was only a moderate (29%) increase in hospitalizations during this period for this group. Inflation-adjusted hospital charges per hospitalization increased from $84,722 in 1997 to $117,081 in 2006 (+38%). More than 50% of the patients were discharged to a skilled nursing facility. The in-hospital mortality rate was stable at about 12% ( Fig. 1 lower ). TABLE 2: Hospitalizations associated with cervical spine fractures with SCI from 1997 to 2006 Variable Year 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

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Daniel D. Cavalcanti, Nikolay L. Martirosyan, Ketan Verma, Sam Safavi-Abbasi, Randall W. Porter, Nicholas Theodore, Volker K. H. Sonntag, Curtis A. Dickman and Robert F. Spetzler

vertebral and cerebellar arteries at risk. Consequently, their dissection can be challenging. Once contemporary studies report mortality rates of 0%, the primary focus related to management of schwannomas in the CCJ becomes the preservation and restoration of function of the lower CNs and of hearing and facial nerve function. 2 , 17 , 31 , 43 , 44 , 51 Different surgical approaches have been used to facilitate the resection of tumors involving the CCJ and to reduce postoperative morbidity. 7 , 9 , 13 , 15 , 19 , 27 The far-lateral approach has been used to manage

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Nikolay L. Martirosyan, Jeanne S. Feuerstein, Nicholas Theodore, Daniel D. Cavalcanti, Robert F. Spetzler and Mark C. Preul

paraplegia or paraparesis was 16%. In a study of 121 cases of thoracoabdominal aortic aneurysm repair by Cinà and associates, 11 neurological deficits were recorded in 6.2% of patients, and the hospital mortality rate was 21.4%. The complexity of the repair is a significant predictor of SCI. The Crawford classification system 16 organizes thoracoabdominal aortic aneurysm repairs based on the extent and position: Type I aneurysms extend from the proximal descending thoracic aorta to the upper abdominal aorta; Type II aneurysms from the proximal descending thoracic aorta

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performed 4,260 (74.7%) operations while candidate members performed 1,439 (25.3%) operations. Of those, 1,153 (20.2%) were revisions. A total of 707 (12.4%) complications were recorded, 519 (12.2%) for active and 188 (13.1%) for candidate members, respectively (p=0.380). Mortality rate was 0.26%. Spinal cord complications accounted for 0.61% of all cases. Active members had 21(0.49%) spinal cord complications, while candidates had 14 (0.98%) (p=0.051). There were a total of 178 (3.1%) surgical site infections (SSI). Active members had 82 (1.9%) deep SSI, while candidate