Acute traumatic unilateral cervical C4–C5 facet dislocation
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Cervical spinal cord injury without radiographic abnormalities is more commonly seen in the pediatric age group than in adults. Incidences have been reported as 13–19% of spinal injuries in children . However, the trauma of C3-C7 lower cervical area is especially seen in adolescence and the advanced childhood period. Facet dislocations can be unilateral or bilateral. They generally develop in connection to the hyperflexion traumas accompanied by rotation.Compared with unilateral, bilateral facet dislocations are more unstable pathologies. Cases of unilateral cervical C4–C5 facet dislocation in toddlers is very rare. In early diagnosis cases, reduction can be ensured by traction. In cases in which reduction is ensured, 2–4 months immobilization must be provided.

Case presentation

A 3-year-old girl suffered cervical spine injury after a motor vehicle collision while sitting in the car without wearing a seatbelt. Paediatric surgeon and orthopedic team re-evaluated that the status of the patient showed head injury with alteration of consciousness, intubation, cervical spine protection with hard collar and first rib fracture without pneumohemothorax. The emergency radiographs x-ray and CT brain including cervical spine showed no intracerebral hemorrhage but the cervical spine suffered unilateral cervical C4–C5 facet dislocation.

Radiographic features showed anterior dislocation of the affected vertebral body less than the vertebral body in anterior posterior diameter, discordant rotation above and below involved level, facet within intervertebral foramen on oblique view, widening of the disk space and “Bat wing sign” appearance of the overriding facet. The patient was taken to the pediatric intensive care unit (PICU) for resuscitation and closed monitoring after hemodynamic was stable. The patient was evaluated by MRI for preoperative planning, and no spinal cord injury was visible. In the next 24 hours, the patient’s neurovascular status examination was fully conscious and no neurological deficit (Frankel grade E) then extubation followed. They applied closed reduction maneuver with minerva cast under sedation. The patient was in Frankel grade E without complication after closed reduction and the cervical spine had good alignment in radiographs. The minerva cast was removed at 8 weeks, at which point the neck muscle stretching rehabilitation program started. At one-year follow up, the child was asymptomatic, had full active cervical motion and good function. The cervical spine showed normal alignment and had healed in follow up radiographs.

Purpose of this case was to highlight the challenges in managing cervical spine injuries in toddlers without neurological deficit. Case described the management of an acute pediatric unilateral facet dislocation by manual reduction and stabilization with minerva cast.

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