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Cervicothoracic dislocation due to congenital and bone-dysplasia-related vertebral malformations

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Abstract

Purpose

To evaluate the approaches to treatment of congenital and bone-dysplasia-related pediatric cervicothoracic dislocations and define the optimal treatment method.

Methods

The publications available in PubMed and Google Scholar data bases were selected following such criteria as the disease in question, pediatric age, the treatment description, and follow-up results. The paper also includes the descriptions of our own six cases of the cervicothoracic dislocations detected in children with different vertebral malformations.

Results

Only eight patients meeting the abovementioned selection criteria were found in the publications: three of them had the Klippel–Feil syndrome (KFS), two had one-level vertebral anomaly, one had neurofibromatosis (NF type 1), one had the Larsen syndrome, and one had a variation of VACTERL association. Their treatment was long term, multi stage, and complicated. Among six our own cases, four patients also had KFS, one had a variation of VACTERL association, and one had NF type 1. All the patients suffered from preoperative neurological disorders. Posterior instrumental fixation with posterior vertebral body resection was performed in four cases and one patient underwent a combined surgery. The parents of one of the patients refused the operation, so he was observed while receiving bracing treatment. Since the treatment was long term and complicated by reoperations, the average follow-up period comprised 5 years.

Conclusion

Congenital cervicothoracic dislocations are an extremely rare pathology that manifests itself in early age and requires an early surgical treatment. Failure to provide the treatment leads to the patient’s disability. The surgical tactics for such patients is determined individually, but the published data and our own experience demonstrate that early multi-stage combined treatment has been the best option available so far. The cervicothoracic dislocations due to NF 1 manifest later and have a more favorable forecast.

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Data availability

All patient data is stored in the electronic database of the Ilizarov Center, access to which is restricted by the legislation of the country. In this article, we have attempted to provide detailed information about patients in Tables 2, 3 and in Figs 1, 2, 3, 4, 5, and 6.

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Funding

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Authors and Affiliations

  1. Ilizarov Center, Kurgan, Russia

    Olga M. Sergeenko, Alexey V. Evsyukov, Egor Yu. Filatov, Sergey O. Ryabykh, Alexander V. Burtsev & Alexander V. Gubin

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  1. Olga M. Sergeenko
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  2. Alexey V. Evsyukov
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  3. Egor Yu. Filatov
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Contributions

EUF, OMS, AVE, SOR, AVB, AVG: Made substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data; or the creation of new software used in the work; Drafted the work or revised it critically for important intellectual content; Approved the version to be published; Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Olga M. Sergeenko.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. The authors declare no conflict of interest in this work.

Ethical approval (IRB)

The study has been approved by the Institutional Review Board (IRB) (Approval # 2(62)—05.03.2019). All the procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Sergeenko, O.M., Evsyukov, A.V., Filatov, E.Y. et al. Cervicothoracic dislocation due to congenital and bone-dysplasia-related vertebral malformations. Spine Deform 11, 1223–1238 (2023). https://doi.org/10.1007/s43390-023-00690-1

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