Fractures of the odontoid process are rare in children. We retrospectively
reviewed 15 cases in children younger than 6 years, with an average follow-
up of 4 years and 3 months. Eight of these patients had neurologic involvem
ent; magnetic resonance imaging (MRI) changes were seen in the spinal cord
at the cervicothoracic junction in six. This neurologic injury was thought
to be due to the major anterior displacement of the upper spine, causing sp
inal cord stretch at the spinal apex of the cervical and thoracic spine. Ei
ght patients secured in forward-facing car seats were injured as the result
of motor vehicle accident. Conservatively treated fractures fused without
problem. By contrast, the three cases operated on as the initial management
of the fracture had complications postoperatively.