THE ANTERIOR CERVICAL APPROACH FOR TRAUMATIC INJURIES TO THE CERVICAL-SPINE IN CHILDREN

In most cases of traumatic cervical spine injuries in children, nonope rative treatment, mainly external stabilization, is sufficient. When o perative treatment is chosen, surgeons often recommend posterior stabi lization. In a subset of pediatric patients, the anterior approach is indicated. The anterior operative approach was employed in six childre n three to 14 years of age who sustained trauma to the cervical spine. The injuries included severe hyperflexion injury with crush fracture and avulsion of the vertebral body, fracture-dislocation of the verteb ral body with involvement of the posterior elements and the disk, and injuries that caused major anatomic deformity of the cervical spine wi th cord compression. Anterior decompression with bony fusion led to no rmal anatomic alignment with neurologic improvement in all patients. F ollow-up evaluation as long as eight years showed solid fusion and rem odeling of the bone grafts. The anterior approach should be used more frequently as the surgical procedure of choice in children with trauma tic lesions of the cervical spine. The anterior approach provided dire ct visualization of the lesion, which enabled effective repair and sta bilization, early ambulation with minimal morbidity, and significant l ong-term neurologic improvement.